EP1691811A1 - Kombination aus einem sedativum und einem neurotransmitter-modulator und verfahren zur verbesserung der schlafqualität und zur behandlung von depression - Google Patents
Kombination aus einem sedativum und einem neurotransmitter-modulator und verfahren zur verbesserung der schlafqualität und zur behandlung von depressionInfo
- Publication number
- EP1691811A1 EP1691811A1 EP04813295A EP04813295A EP1691811A1 EP 1691811 A1 EP1691811 A1 EP 1691811A1 EP 04813295 A EP04813295 A EP 04813295A EP 04813295 A EP04813295 A EP 04813295A EP 1691811 A1 EP1691811 A1 EP 1691811A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- pharmaceutically acceptable
- solvate
- crystal
- polymoφh
- acceptable salt
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 239000000932 sedative agent Substances 0.000 title claims description 214
- 238000000034 method Methods 0.000 title abstract description 58
- 239000002858 neurotransmitter agent Substances 0.000 title description 13
- 230000001624 sedative effect Effects 0.000 title description 5
- 230000003860 sleep quality Effects 0.000 title description 3
- GBBSUAFBMRNDJC-INIZCTEOSA-N eszopiclone Chemical compound C1CN(C)CCN1C(=O)O[C@H]1C2=NC=CN=C2C(=O)N1C1=CC=C(Cl)C=N1 GBBSUAFBMRNDJC-INIZCTEOSA-N 0.000 claims abstract description 168
- 229960001578 eszopiclone Drugs 0.000 claims abstract description 157
- 150000001875 compounds Chemical class 0.000 claims abstract description 127
- 239000008194 pharmaceutical composition Substances 0.000 claims abstract description 116
- 102000005915 GABA Receptors Human genes 0.000 claims abstract description 115
- 108010005551 GABA Receptors Proteins 0.000 claims abstract description 114
- 230000000694 effects Effects 0.000 claims abstract description 113
- 239000003772 serotonin uptake inhibitor Substances 0.000 claims abstract description 102
- 208000013738 Sleep Initiation and Maintenance disease Diseases 0.000 claims abstract description 98
- 206010022437 insomnia Diseases 0.000 claims abstract description 95
- 229940126570 serotonin reuptake inhibitor Drugs 0.000 claims abstract description 94
- 239000000221 dopamine uptake inhibitor Substances 0.000 claims abstract description 90
- RTHCYVBBDHJXIQ-MRXNPFEDSA-N (R)-fluoxetine Chemical compound O([C@H](CCNC)C=1C=CC=CC=1)C1=CC=C(C(F)(F)F)C=C1 RTHCYVBBDHJXIQ-MRXNPFEDSA-N 0.000 claims abstract description 86
- 229960002464 fluoxetine Drugs 0.000 claims abstract description 86
- 229940094659 Dopamine reuptake inhibitor Drugs 0.000 claims abstract description 85
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- 239000002767 noradrenalin uptake inhibitor Substances 0.000 claims abstract description 73
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- QZAYGJVTTNCVMB-UHFFFAOYSA-N serotonin Chemical compound C1=C(O)C=C2C(CCN)=CNC2=C1 QZAYGJVTTNCVMB-UHFFFAOYSA-N 0.000 claims description 160
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- 229960000820 zopiclone Drugs 0.000 claims description 83
- GBBSUAFBMRNDJC-MRXNPFEDSA-N (5R)-zopiclone Chemical compound C1CN(C)CCN1C(=O)O[C@@H]1C2=NC=CN=C2C(=O)N1C1=CC=C(Cl)C=N1 GBBSUAFBMRNDJC-MRXNPFEDSA-N 0.000 claims description 77
- AHOUBRCZNHFOSL-UHFFFAOYSA-N Paroxetine hydrochloride Natural products C1=CC(F)=CC=C1C1C(COC=2C=C3OCOC3=CC=2)CNCC1 AHOUBRCZNHFOSL-UHFFFAOYSA-N 0.000 claims description 70
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- AHOUBRCZNHFOSL-YOEHRIQHSA-N (+)-Casbol Chemical compound C1=CC(F)=CC=C1[C@H]1[C@H](COC=2C=C3OCOC3=CC=2)CNCC1 AHOUBRCZNHFOSL-YOEHRIQHSA-N 0.000 claims description 64
- SNPPWIUOZRMYNY-UHFFFAOYSA-N bupropion Chemical compound CC(C)(C)NC(C)C(=O)C1=CC=CC(Cl)=C1 SNPPWIUOZRMYNY-UHFFFAOYSA-N 0.000 claims description 61
- HXTGXYRHXAGCFP-OAQYLSRUSA-N (r)-(2,3-dimethoxyphenyl)-[1-[2-(4-fluorophenyl)ethyl]piperidin-4-yl]methanol Chemical group COC1=CC=CC([C@H](O)C2CCN(CCC=3C=CC(F)=CC=3)CC2)=C1OC HXTGXYRHXAGCFP-OAQYLSRUSA-N 0.000 claims description 59
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- GJJFMKBJSRMPLA-HIFRSBDPSA-N (1R,2S)-2-(aminomethyl)-N,N-diethyl-1-phenyl-1-cyclopropanecarboxamide Chemical compound C=1C=CC=CC=1[C@@]1(C(=O)N(CC)CC)C[C@@H]1CN GJJFMKBJSRMPLA-HIFRSBDPSA-N 0.000 claims description 54
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- RCOBKSKAZMVBHT-TVQRCGJNSA-N radafaxine Chemical compound C[C@@H]1NC(C)(C)CO[C@@]1(O)C1=CC=CC(Cl)=C1 RCOBKSKAZMVBHT-TVQRCGJNSA-N 0.000 claims description 46
- PNVNVHUZROJLTJ-UHFFFAOYSA-N venlafaxine Chemical compound C1=CC(OC)=CC=C1C(CN(C)C)C1(O)CCCCC1 PNVNVHUZROJLTJ-UHFFFAOYSA-N 0.000 claims description 45
- VGIGHGMPMUCLIQ-UHFFFAOYSA-N LSM-2183 Chemical compound C1=CC(F)=CC=C1N1CCN(CCCN2S(C=3C=CC=C4C=CC=C2C=34)(=O)=O)CC1 VGIGHGMPMUCLIQ-UHFFFAOYSA-N 0.000 claims description 44
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- CJOFXWAVKWHTFT-XSFVSMFZSA-N fluvoxamine Chemical compound COCCCC\C(=N/OCCN)C1=CC=C(C(F)(F)F)C=C1 CJOFXWAVKWHTFT-XSFVSMFZSA-N 0.000 claims description 44
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- FDXQKWSTUZCCTM-UHFFFAOYSA-N oxaprotiline Chemical compound C12=CC=CC=C2C2(CC(O)CNC)C3=CC=CC=C3C1CC2 FDXQKWSTUZCCTM-UHFFFAOYSA-N 0.000 claims description 40
- ZAFYATHCZYHLPB-UHFFFAOYSA-N zolpidem Chemical compound N1=C2C=CC(C)=CN2C(CC(=O)N(C)C)=C1C1=CC=C(C)C=C1 ZAFYATHCZYHLPB-UHFFFAOYSA-N 0.000 claims description 40
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- HCYAFALTSJYZDH-UHFFFAOYSA-N Desimpramine Chemical group C1CC2=CC=CC=C2N(CCCNC)C2=CC=CC=C21 HCYAFALTSJYZDH-UHFFFAOYSA-N 0.000 claims description 39
- 229960003914 desipramine Drugs 0.000 claims description 39
- 239000000203 mixture Substances 0.000 claims description 39
- HUNXMJYCHXQEGX-UHFFFAOYSA-N zaleplon Chemical compound CCN(C(C)=O)C1=CC=CC(C=2N3N=CC(=C3N=CC=2)C#N)=C1 HUNXMJYCHXQEGX-UHFFFAOYSA-N 0.000 claims description 39
- 229960004010 zaleplon Drugs 0.000 claims description 39
- WSEQXVZVJXJVFP-HXUWFJFHSA-N (R)-citalopram Chemical group C1([C@@]2(C3=CC=C(C=C3CO2)C#N)CCCN(C)C)=CC=C(F)C=C1 WSEQXVZVJXJVFP-HXUWFJFHSA-N 0.000 claims description 37
- 150000004030 azacyclic compounds Chemical class 0.000 claims description 37
- 229960001653 citalopram Drugs 0.000 claims description 37
- KLLLJCACIRKBDT-UHFFFAOYSA-N 2-phenyl-1H-indole Chemical class N1C2=CC=CC=C2C=C1C1=CC=CC=C1 KLLLJCACIRKBDT-UHFFFAOYSA-N 0.000 claims description 36
- 150000002917 oxazolidines Chemical class 0.000 claims description 36
- 125000003386 piperidinyl group Chemical group 0.000 claims description 36
- VGKDLMBJGBXTGI-SJCJKPOMSA-N sertraline Chemical compound C1([C@@H]2CC[C@@H](C3=CC=CC=C32)NC)=CC=C(Cl)C(Cl)=C1 VGKDLMBJGBXTGI-SJCJKPOMSA-N 0.000 claims description 36
- ZEUITGRIYCTCEM-KRWDZBQOSA-N (S)-duloxetine Chemical compound C1([C@@H](OC=2C3=CC=CC=C3C=CC=2)CCNC)=CC=CS1 ZEUITGRIYCTCEM-KRWDZBQOSA-N 0.000 claims description 35
- RAQPOZGWANIDQT-UHFFFAOYSA-N 1-[2-(benzhydryloxy)ethyl]-4-(3-phenylpropyl)piperazine Chemical compound C=1C=CC=CC=1CCCN(CC1)CCN1CCOC(C=1C=CC=CC=1)C1=CC=CC=C1 RAQPOZGWANIDQT-UHFFFAOYSA-N 0.000 claims description 35
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- 235000019786 weight gain Nutrition 0.000 description 1
- 238000005550 wet granulation Methods 0.000 description 1
- 229960002791 zimeldine Drugs 0.000 description 1
- OYPPVKRFBIWMSX-SXGWCWSVSA-N zimeldine Chemical compound C=1C=CN=CC=1C(=C/CN(C)C)\C1=CC=C(Br)C=C1 OYPPVKRFBIWMSX-SXGWCWSVSA-N 0.000 description 1
- 229960005111 zolpidem tartrate Drugs 0.000 description 1
- 108020001612 μ-opioid receptors Proteins 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/4985—Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/13—Amines
- A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
- A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/13—Amines
- A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
- A61K31/138—Aryloxyalkylamines, e.g. propranolol, tamoxifen, phenoxybenzamine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/70—Carbohydrates; Sugars; Derivatives thereof
- A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
- A61K31/716—Glucans
- A61K31/724—Cyclodextrins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
- A61P25/20—Hypnotics; Sedatives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P25/00—Drugs for disorders of the nervous system
- A61P25/24—Antidepressants
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
Definitions
- rhythmic circadian influences are an alerting pulse in the evening and in the morning. It is the interaction of these processes which give rise to the 24-hour sleep schedule.
- sleep onset in the evening occurs primarily as a function of homeostatic drive.
- homeostatic drive dissipates significantly and wakefulness begins to intrude into the sleep period. This propensity to increased wakefulness is further increased by the rise in the circadian alerting pulse at about 5 AM.
- two vulnerabilities have been recognized. The first is difficulty initially falling asleep, with the second being reawakening in the middle of the night.
- insomnia is associated with abnormalities in these rhythms.
- the time, within a 24 hour period, of administration of drugs for the prevention and treatment of such disorders can be a critical factor in determining efficacy of the therapy.
- the term "insomnia” refers to the perception of inadequate or non-restful sleep by a patient. Insomnia is a frequent complaint, reported by 32% of the adult population surveyed in the Los Angeles area (Bixler et al, Amer.
- insomnia central nervous system
- zolpidem marketed by Sanofi-Synthelabo as AMBIEN® (zolpidem tartrate), which is based on the imidazopyridine backbone (see U.S. Pat. Nos. 4,382,938 and 4,460,592).
- AMBIEN® zolpidem tartrate
- zaleplon which is marketed by Jones Pharma as SONATA®
- SONATA® was been approved by the FDA; zaleplon is a pyrazolopyrimidine- based compound (see U.S. Pat. No. 4,626,538).
- Norepinephrine also called noradrenaline, is a neurotransmitter that doubles part-time as a hormone.
- norepinephrine helps to regulate arousal, dreaming, and moods.
- As a hormone it acts to increase blood pressure, constrict blood vessels and increase heart rate - responses that occur when we feel stress.
- Serotonin (5-hydroxynyptamine, 5-HT) is widely distributed in animals and plants, occurring in vertebrates, fruits, nuts, and venoms. A number of congeners of serotonin are also found in nature and have been shown to possess a variety of peripheral and central nervous system activities.
- Serotonin may be obtained from a variety of dietary sources; however, endogenous 5-HT is synthesized from tryptophan through the actions of the enzymes tryptophan hydroxylase and aromatic L-amino acid decarboxylase. Both dietary and endogenous 5-HT are rapidly metabolized and inactivated by monoamine oxidase and aldehyde dehydrogenase to the major metabolite, 5-hydroxyindoleacetic acid (5-HIAA). Serotonin is implicated in the etiology or treatment of various disorders, particularly those of the central nervous system, including anxiety, depression, obsessive-compulsive disorder, schizophrenia, stroke, obesity, pain, hypertension, vascular disorders, migraine, and nausea.
- various disorders particularly those of the central nervous system, including anxiety, depression, obsessive-compulsive disorder, schizophrenia, stroke, obesity, pain, hypertension, vascular disorders, migraine, and nausea.
- Neurotransmitters produce their effects as a consequence of interactions with cellular receptors.
- Neurotransmitters including serotonin, are synthesized in brain neurons and stored in vesicles. Upon a nerve impulse, they are released into the synaptic cleft, where they interact with various postsynaptic receptors.
- the actions of 5-HT are terminated by three major mechanisms: diffusion; metabolism; and uptake back into the synaptic cleft through the actions of specific amine membrane transporter systems.
- the major mechanism by which the action of serotonin is terminated is by uptake through presynaptic membranes.
- 5-HT acts on its various postsynaptic receptors, it is removed from the synaptic cleft back into the nerve terminal through an uptake mechanism involving a specific membrane transporter in a manner similar to that of other biogenic amines.
- the actions of 5-HT, or any neurotransmitter can be modulated by agents that: stimulate or inhibit its biosynthesis; agents that block its storage; agents that stimulate or inhibit its release; agents that mimic or inhibit its actions at its various postsynaptic receptors; agents that inhibit its reuptake into the nerve terminal; and agents that affect its metabolism.
- the present invention generally relates to pharmaceutical compositions comprising a sedative agent; and an antidepressant, including without limitation serotonin reuptake inhbitors, norepinephrine reuptake inhibitors, dopamine reuptake inhibitors, CRS antagonists and 5-HT 2A receptor modulators.
- the sedative agent is a GABA receptor modulating compound.
- the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- the pharmaceutical compositions of the invention are useful in the treatment of various sleep disorders.
- the present invention also relates to a method of treating a patient suffering from a sleep abnormality, insomnia, or depression comprising administering a therapeutically effective amount of a pharmaceutical composition of the invention.
- the present invention relates to a method for augmentation of antidepressant therapy in a patient comprising administering to the patient a therapeutically effective amount of a sedative agent.
- the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- the present invention also relates to a method for eliciting a dose-sparing effect in a patient undergoing treatment with an antidepressant comprising administering to the patient a therapeutically effective amount of a sedative agent, h a preferred embodiment, the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof. Furthermore, the present invention relates to a method for reducing depression relapse in a patient who received antidepressant treatment comprising administering to the patient a therapeutically effective amount of a sedative agent. In one embodiment, the sedative agent is administered chronically or long-term. In a preferred embodiment, the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- Figure 3 depicts a schematic diagram of a clinical-study protocol used to assess the safety and efficacy of compositions and methods of the present invention.
- Figure 4 depicts graphically fluoxetine titration as a function of length of treatment and co-administration with a placebo or eszopiclone.
- Figure 5 depicts graphically Subjective Wake Time After Sleep Onset (WASO) as a function of length of treatment with a placebo or eszopiclone.
- Figure 6 depicts a chart of Subjective Sleep Latency (SL) as a function of length of treatment with a placebo or eszopiclone.
- Figure 7 depicts a chart of Subjective Total Sleep Time (TST) as a function of length of treatment with a placebo or eszopiclone.
- Figure 8 depicts a chart of improvement from baseline in Ham-D-17 as a function of length of treatment with a placebo or eszopiclone.
- Figure 9 depicts a chart of improvement from baseline in Ham-D-17 (excluding questions related to insomnia) as a function of length of treatment with a placebo or eszopiclone.
- Figure 10 depicts a chart of improvement from baseline in Clinical Global Impression (severity) as a function of length of treatment with a placebo or eszopiclone.
- Figure 11 depicts a chart of Clinical Global Impression (Global Improvement) as a function of length of treatment with a placebo or eszopiclone.
- Figure 12 depicts a graph of Time to Onset of 50% Antidepressant Response on HAM-
- FIG. 14 depicts an Insomnia Severity Index (ISI) questionnaire used in the clinical- study protocol to assess the safety and efficacy of compositions and methods of the present invention.
- Figure 15 depicts a portion of an Acute Health Survey questionnaire used in the clinical-study protocol to assess the safety and efficacy of compositions and methods of the present invention.
- Figure 16 depicts a portion of an Acute Health Survey questionnaire used in the clinical-study protocol to assess the safety and efficacy of compositions and methods of the present invention.
- the present invention relates generally to pharmaceutical compositions containing two or more active agents that when taken together improve the quality of sleep for a patient.
- the present invention relates to a pharmaceutical composition comprising an antidepressent and a sedative agent.
- the present invention relates to a pharmaceutical composition comprising a serotonin reuptake inhibitor and a sedative agent.
- the present invention relates to a pharmaceutical composition comprising a NRI and a sedative agent.
- the present invention relates to a pharmaceutical composition comprising a 5-HT A modulator and a sedative agent.
- the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising a dopamine reuptake inhibitor and a sedative agent.
- the sedative agent is a GABA receptor modulating compound.
- the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clatherate, polymorph, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep disorder comprising the step of administering to said patient a therapeutically effective dose of a pharmaceutical composition containing two or more active agents that when taken together improve the quality of sleep or sleep disorders for said patient.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression comprising the step of administering to said patient a therapeutically effective dose of a pharmaceutical composition of the invention.
- said pharmaceutical composition comprises a serotonin reuptake inhibitor and a sedative agent.
- said pharmaceutical composition comprises a norepinephrine reuptake inhibitor and a sedative agent.
- said pharmaceutical composition comprises a 5-HT A modulator and a sedative agent.
- said pharmaceutical composition comprises a dopamine reuptake inhibitor and a sedative agent.
- the sedative is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof
- said pharmaceutical composition comprises eszopiclone and a SRI.
- said pharmaceutical composition comprises eszopiclone and fluxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal of any one or both of them.
- the present invention relates to a method for augmentation of antidepressant therapy in a patient comprising administering to the patient a therapeutically effective amount of a sedative agent.
- the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- the present invention also relates to a method for eliciting a dose-sparing effect in a patient undergoing treatment with an antidepressant comprising administering to the patient a therapeutically effective amount of a sedative agent.
- the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- the present invention relates to a method for reducing depression relapse in a patient who received antidepressant treatment comprising administering to the patient a therapeutically effective amount of a sedative agent.
- the sedative agent is administered chronically or long-term.
- the sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- insomnia In addition, of those reporting insomnia symptoms at least a few nights a week, 40% reported feeling unrefreshed upon awakening, 36% reported being awake a lot during the night, 25% reported difficulty falling asleep, and 24% reported waking up too early and being unable to fall back asleep.
- the major types of insomnia are often described as primary and secondary insomnia (as in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Text Revision. 4th ed. Washington, DC: American Psychiatric Publishing, Inc,
- DSM chronic versus acute/transient insomnia
- intrinsic versus extrinsic insomnia as in the International Classification of Sleep Disorders [ICSD]
- sleep-onset versus sleep maintenance Diagnostic Classification Steering Committee. International Classification of Sleep Disorders (ICSD): Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association, 1990).
- ICSD International Classification of Sleep Disorders
- Many patients with sleep disturbance will fall into more than one of these categories or will have unspecified dissatisfaction with the quality of their sleep (Roth T. Int. J. Clin. Pract. Suppl. 2001,3-8).
- the fourth edition of the DSM defines insomnia as difficulties in sleep onset (or initiation), difficulties in sleep maintenance, or sleep that is nonrestorative. Chronic insomnia may result from several different sources (Rajput et al., Am. Fam.
- Sleep maintenance problems may take several forms, including frequent awakenings, an increase in time spent awake after initially falling asleep (wake time after sleep onset, or
- WASO which is a robust measure of sleep maintenance), sleep fragmentation (transient microarousals appearing on an EEG but not necessarily involving full wakefulness), and unrefreshing sleep. Of these, WASO is a particularly sensitive measure of sleep improvement.
- WASO may include a number of microarousals, as well as all periods of full wakefulness, and thus increases in WASO of only a few minutes may be indicative of substantially improved sleep continuity.
- the severity of insomnia can be directly correlated to severity of next-day functional impairment.
- patients with chrome insomnia experience a subjective deterioration in waking behaviors and psychosocial functioning, including impaired memory, concentration, ability to accomplish tasks, and enjoyment of interpersonal relationships (Roth et al., Sleep, 1999, 22 Suppl 2:S354-
- Depression Psychiatric disorders are pathological conditions of the brain characterized by identifiable symptoms that result in abnormalities in cognition, emotion or mood, or the highest integrative aspects of behavior. These disorders may vary in severity of symptoms, duration, and functional impairment. Psychiatric disorders afflict millions of people worldwide resulting in tremendous human suffering and economic burden due to lost productivity. Mood disorders are a type of psychiatric disorder often defined as a group of heterogeneous, typically recurrent illnesses including unipolar (depressive) and bipolar (manic-depressive) disorders characterized by pervasive mood disturbances, psychomotor dysfunction, and vegetative symptoms.
- Suicide the most serious complication in patients with mood disorders, is the cause of death in 15 to 25% of untreated patients with mood disorders; unrecognized or inadequately treated depression contributes to 50 to 70% of all completed suicides.
- Depression is an affective disorder, the pathogenesis of which cannot be explained by any single cause or theory.
- the most widely accepted hypothesis involves abnormal function of the catecholamine (primarily norepinephrine) and/or serotonin transmitter systems. In this hypothesis, most forms of depression are associated with a deficiency of norepinephrine and/or serotonin at functionally important adrenergic or serotonergic receptors.
- NE norepinephrine
- MAOIs agents that increase the levels of NE and 5-HT by inhibiting their metabolism
- drugs that increase these levels at the receptor by inhibiting the uptake of NE and 5-HT drugs that increase these levels at the receptor by inhibiting the uptake of NE and 5-HT.
- TCAs tricyclic antidepressants
- Tertiary amines such as imipramine and amitriptyline are more selective inhibitors of 5-HT than catecholamines, compared with secondary amines such as desipramine.
- selective 5-HT reuptake inhibitors SSRIs
- Fluoxetine (PROZAC ® ), sertraline (ZOLOFT ® ), and paroxetine (PAXIL ® ) have gained immediate acceptance, each appearing in recent listings of the top 200 prescription drugs. Fluoxetine was approved also for the treatment of obsessive-compulsive disorder. These agents do not appear to possess greater efficacy than the TCAs, nor do they generally possess a faster onset of action; however, they do have the advantage of a lower side-effect profile. Of these three SSRIs, paroxetine is the most potent inhibitor of 5-HT uptake, fluoxetine the least. Sertaline is the most selective for 5- HT versus NE uptake, fluoxetine the least selective.
- Fluoxetine and sertraline produce active metabolites, while paroxetine is metabolized to inactive metabolites.
- the SSRIs in general, affect only the uptake of serotonin and display little or no affinity for various receptor systems including muscarinic, adrenergic, dopamine, histamine, or 5-HT receptors.
- Venlafaxine EFFEXOR ®
- EFFEXOR ® is a recently introduced antidepressant, differing from the classical TCAs and the SSRIs chemically and pharmacologically in that it acts as a potent inhibitor of both 5-HT and norepinephrine uptake, as well as weakly inhibiting dopamine uptake.
- Venlafaxine Its major metabolite, O-desmethylvenlafaxine, shares a similar profile. Neither venlafaxine nor its major metabolite have significant affinity for muscarinic, histaminergic, benzodiazephine, mu opioid, or adrenergic alpha- 1 receptors. It is administered as a racemic mixture. Both enantiomers inhibit 5-HT and NE uptake, but the (S)(+)-isomer is more selective for 5-HT uptake. Venlafaxine possesses an efficacy equivalent to that of the TCAs, and a benign side effect profile similar to those of the SSRIs. Unfortunately, treatment options for depressed patients who have suboptimal clinical responses to therapy with an antidepressant are limited.
- the most common approaches that many clinicians will pursue are: a) switching to another antidepressant; or b) adding a second antidepressant; or c) attempting an augmentation therapy by administering agents such as lithium carbonate, thyroid hormone (triiodothyronine), psychostimulants, modafinil, atypical antipsychotics, buspirone, or pindolol.
- agents such as lithium carbonate, thyroid hormone (triiodothyronine), psychostimulants, modafinil, atypical antipsychotics, buspirone, or pindolol.
- the first involves switching the patient to another antidepressant agent that may have different pharmacodynamic and pharmacokinetic characteristics from the first agent.
- the second attempts to utilize an antidepressant agent that will produce synergistic effects with the first agent.
- the third approach relies on potential augmentation of the concurrently administered original antidepressant by agents that in and of themselves may have limited or no direct antidepressant effect.
- the pharmacological mechanism of action for any of the commonly used augmentation agents described above and in the literature is not established, and data from controlled clinical trials to support the use of these and other agents to bring about an augmentation of antidepressant treatment is sparse.
- the most thoroughly researched agents that are utilized in many patients with antidepressant-resistant depression are lithium and thyroid hormone. Several clinical trials with these two agents have shown that augmentation with lithium or thyroid hormone is effective.
- central nervous system stimulants may also produce an augmentation effect in antidepressant therapy, but there is concern that these agents can produce tolerance and put the patient at risk for physical and psychological dependence and possible drug abuse.
- Some clinicians utilize atypical antipsychotics at low doses and buspirone which are generally well tolerated and may have additional utility in treating concomitant anxiety in depressed patients that are refractory to their antidepressants. Pindolol has also been shown to accelerate clinical responses in some but not all clinical studies reported.
- Serotonin Reuptake Inhibitors In general, a dose of an SRI or a pharmaceutically acceptable salt thereof suitable for administration to a human will be in the range of 0.01 to 50 mg per kilogram body weight of the recipient per day, preferably in the range of 0.1 to 3 mg per kilogram body weight per day. Unless otherwise stated all weights of active ingredients are calculated in terms of drug per se. In certain embodiments, the desired dose is presented as two, three, four, five or more sub- doses administered at appropriate intervals throughout the day. These sub-doses may be administered in unit dosage forms, for example, containing about 5 to 50 mg. Citalopram Citalopram is a selective, centrally acting serotonin reuptake inhibitor having antidepressant activities.
- the antidepressant activity of the compound has been reported in several publications, e.g., J. H ttol Prog. Neuro-Psychopharniacol & Biol Psychiat. 1982, 6, 277-295; and A. Gravem ⁇ ct ⁇ Psychiatr. Scand. 1987, 75, 478-486.
- the compound has further been disclosed to show effects in the treatment of dementia and cerebrovascular disorders. See EP-A 474580. Christensen et al. reported on the pharmacology of citalopram in Eur. J.
- citalopram is administered in the form of its hydrobromide salt marketed under the name Cipralmil.
- Citalopram has the chemical name l-[3-(dimethylamino)propyl]-l-(4-fluorophenyl)- l,3-dihydro-5-isobenzofuran carbonitrile. Citalopram was first disclosed in DE 2,657,271 and U.S. Pat No. 4,136,193. The structure of citalopram is presented below.
- the size of a prophylactic or therapeutic dose of citalopram in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 80 mg.
- a daily dose range should be between about 5 mg to about 50 mg.
- a daily dose range should be between about 10 mg to about 30 mg.
- a daily dosage of 15, 20, or 25 mg may be preferred depending upon patient response.
- Duloxetine (CYMBALTA ® )
- Duloxetine is an antidepressant that functions by inhibiting the reuptake of serotonin and norepinephrine.
- Duloxetine has the chemical name N-methyl-3-(l-naphthalenyloxy)-3-(2- thienyl)propanamine and is usually administered as the hydrochloride salt. In certain instances, duloxetine is administered as the (+) enantiomer.
- duloxetine will be used here to refer to any acid addition salt or the free base of the molecule.
- Duloxetine was first taught by U.S. Pat. No. 4,956,388, which discloses its high potency.
- Duloxetine is generally administered orally in the form of a tablet or a capsule full of enteric coated granules. The chemical structure of duloxetine is given below.
- the size of a prophylactic or therapeutic dose of duloxetine in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 150 mg.
- a daily dose range should be between about 5 mg to about 80 mg.
- a daily dose range should be between about 5 mg to about 50 mg.
- a daily dosage of 10, 20, or 30 mg may be preferred depending upon patient response.
- the therapy may be initiated at a lower dose, perhaps about 4 mg to about 6 mg and increased up to about 10 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases.
- Escitalopram Escitalopram is the S-enantiomer of citalopram. Escitalopram is greater than 100 times more potent in inhibiting serotonin reuptake compared to the R-enantiomer. Escitalopram does significantly affect reuptake of norepinephrine or dopamine.
- escitalopram has negligible affinity for the adrenergic, dopamine (D 1-5 ), histamine (H 1-3 ), muscarinic (M 1-5 ), and benzodiazepine receptors.
- escitalopram is administered as its oxalate salt under the name LEXAPROTM.
- Escitalopram has the chemical name (S)-(+)-l-[3-(dimethylamino)propyl]-l-(4- fluorophenyl)-l,3-dihydro-5-isobenzofuran carbonitrile oxalate.
- Citalopram was first disclosed in DE 2,657,271, corresponding to U.S. Pat No. 4,136,193. The structure of citalopram is presented below.
- the size of a prophylactic or therapeutic dose of escitalopram in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 80 mg.
- a daily dose range should be between about 5 mg to about 50 mg.
- a daily dose range should be between about 10 mg to about 30 mg.
- a daily dosage of 15, 20, or 25 mg may be preferred depending upon patient response.
- the therapy may be initiated at a lower dose, perhaps about 4 mg to about 6 mg and increased up to about 10 mg or higher depending on the patient's global response. In elderly patients, a 10 mg dosage may be optimal. It may be necessary to use dosages outside these ranges in some cases.
- Fluoxetine Fluoxetine is a potent, highly selective reuptake inhibitor of serotonin and is indicated for the treatment of depression and obsessions and compulsions related to obsessive- compulsive disorder (OCD).
- OCD obsessive- compulsive disorder
- the use of fluoxetine for indications other than treating depression is also disclosed in the following: U.S. Pat. Nos.
- Fluoxetine is described in U.S. Pat. No. 4,314,081 and has the chemical name N- methyl-3-(p-trifluormethylphenoxy)3-phenylpropylamine. Fluoxetine is generally marketed as the racemic mixture of its two enantiomers in the form of a hydrochloride salt under the name Prozac.
- Fluoxetine hydrochloride is a white crystalline solid (molecular weight 345.79 g/mol) that has a solubility of 14 mg/mL in water.
- Other methods for the production of fluoxetine and new intermediates are disclosed in U.S. Pat. No. 5,225,585.
- the chemical structure of fluoxetine hydrochloride is shown below:
- fluoxetine hydrochloride PROZAC ®
- fluoxetine hydrochloride has an elimination half- life of from 1-9 days, averaging about 2-3 days. Additional product information, including dosage and administration, can be found in the Physicians' Desk Reference, 48th Edition, 1994, pp. 877-880.
- fluoxetine is generally marketed as the racemic mixture
- Robertson et al. J. Med. Chem. 1988, 31, 1412, taught the separation of the R- and S-enantiomers of fluoxetine and. showed that their activity as serotonin uptake inhibitors is similar to each other.
- U.S. Pat. No. 5,104,899 discloses a method of treating depression in a human patient comprising administering the S-(+)-enantiomer of fluoxetine in substantially optically pure form.
- PCT application WO 95/28152 discloses methods for treating or improving memory, and for treating sexual dysfunction.
- the size of a prophylactic or therapeutic dose of fluoxetine in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 150 mg.
- a daily dose range should be between about 5 mg to about 80 mg.
- a daily dose range should be between about 10 mg to about 20 mg. In certain embodiments, a daily dosage of 30, 40, or 60 mg may be preferred depending upon patient response. In managing the patient, the therapy may be initiated at a lower dose, perhaps about 4 mg to about 8 mg and increased up to about 10 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases.
- Fluvoxamine Fluvoxamine is an inhibitor of serotonin reuptake that is used to treat depression and obsessive-compulsive disorder. Fluvoxamine is described in U.S. Patent 4,085,225 and Neth.
- fluvoxamine 5-methoxy-l-[4-(trifluoromethyl)-phenyl]-l-pentanone
- a prophylactic or therapeutic dose of fluvoxamine in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 600 mg.
- a daily dose range should be between about 10 mg to about 300 mg.
- a daily dose range should be between about 50 mg to about 200 mg.
- a daily dosage of 75, 100, 125, or 150 mg may be preferred depending upon patient response.
- the therapy may be initiated at a lower dose, perhaps about 20 mg to about 25 mg and increased up to about 50 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases. In instances where the dosage is greater than 100 mg per day, the total dosage may need to be administered in two separate doses. A reduced dosage may be required for In elderly patients or patients suffering from liver conditions. Children of 8-17 years of age should be given a starting dose of 25 mg. In certain instances, young girls may need to be given a lower dosage than boys of similar age. Milnacipran Milnacipran is a inhibitor of serotonin and norepinephrine reuptake which is used to treat depression.
- Milnacipran is also known in the art as F2207, TN-912, dalcipran, midalcipran, and midalipran.
- the NE:5-HT selectivity of milnacipran is 2:1. See Moret et al. Neuropharmacology 1985, 24, 1211-1219 and Palmier et al. Eur. J. Clin. Pharmacol. 1989, 3, 235-238. Quite significantly, milnacipran has been used as an antidepressant in approximately 400,000 patients, and is known to be non-toxic in humans. Milnacipran was well tolerated and usually produced no more adverse effects than placebo in clinical trials at dosages of 100 mg/day or 200 mg/day (Spencer and Wilde Drugs 1998, 56, 405-427).
- Milnacipran has the chemical name (N,N-diethyl-2-aminomethyl-l-phenylcyclo- propanecarboxamide). Procedures for the preparation of Milnacipran are given U.S. Pat. No. 4,478,836. The pharmacological activity of Milnacipran is described by Moret and coworkers in Neuropharmacology 1985, 24, 1211-19. Additional information regarding milnacipran may be found in the Merck Index, 12 th Edition, at entry 6281. The structure of Milnacipran is presented below.
- milnacipran may exhibit the phenomena of tautomerism, conformational isomerism, geometric isomerism and/or optical isomerism. It should be understood that the invention encompasses any tautomeric, conformational isomeric, optical isomeric and/or geometric isomeric forms of the NE 5-HT SNRI compounds having one or more of the utilities described herein, as well as mixtures of these various different forms. For example, as is clear from the above structural diagram, milnacipran is optically active.
- milnacipran may be administered in entantiomerically pure form (e.g., the pure dextrogyral enantiomer) or as a mixture of dextogyral and levrogyral enantiomers, such as a racemic mixture.
- entantiomerically pure form e.g., the pure dextrogyral enantiomer
- mixture of dextogyral and levrogyral enantiomers such as a racemic mixture.
- similarcipran refers to both enantiomerically pure forms of milnacipran as well as to mixtures of milnacipran enantiomers.
- the size of a prophylactic or therapeutic dose of milancipran in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 400 mg.
- a daily dose range should be between about 50 mg to about 250 mg.
- a daily dose range should be between about 100 mg to about 200 mg.
- a daily dosage of 1 10, 130, 150, or 170 mg may be preferred depending upon patient response, hi managing the patient, the therapy may be initiated at a lower dose, perhaps about 20 mg to about 30 mg and increased up to about 50 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases.
- Paroxetine Paroxetine is phenylpiperidine compound used to treat major depressive disorder, social anxiety disorder, obsessive compulsive disorder, panic disorder, generalized anxiety disorder, and posttraumatic stress disorder. The therapeutic properties of paroxetine are attributed to inhibition of neuronal reuptake of serotonin.
- Paroxetine is generally marketed as the hydrochloride salt under the name PAXIL ® .
- Paroxetine is reported in U.S. Pat. Nos. 3,912,743 and 4,007, 196 while the activity profile of the drug is given in Lassen et al. Eur. J. Pharmacol. 1978, 47, 351; Hassan et al. Brit. J. Clin. Pharmacol. 1985, 19, 705; Laursen et al. Ada Psychiat. Scand. 1985, 71, 249; and Battegay et al. Neuropsychobiology 1985, 13, 31.
- Dosage forms include immediate release tablets, extended release tablets, capsules and suspensions.
- the active substance in the commercial forms has been paroxetine hydrochloride and specifically with regard to tablets and other solid forms the active ingredient has been paroxetine hydrochloride hemihydrate as described in U.S. Pat. No. 4,721,723 and EP 223403.
- Paroxetine hydrochloride is an off-white powder that has the chemical name (-)-trans 4R-(4'-fluorophenyl)-3S-[(3'4'-methylenedioxy-phenoxy)methyl]-piperidine hydrochloride.
- Paroxetine hydrochloride melts at 120-138 °C, has a molecular weight of 374.8 g/mol, and has a solubility of 5.4 mg/mL in water.
- the structure of paroxetine hydrochloride is presented below.
- U.S. Pat. No. 5,874,447 describes paroxetine sulfonate salts, including paroxetine methane sulfonate also known as paroxetine mesylate. These sulfonate salts have advantageous properties in comparison to the known salts, including the hydrochloride salts. For example, the sulfonate salts have high water solubility and good thermal stability, making them useful in forming a commercial paroxetine dosage form.
- the U.S. Pat. No. 5,874,447 patent discloses that tablets can be made by any known method including a dry technique (direct compression, dry granulation) or a wet technique (wet granulation).
- the size of a prophylactic or therapeutic dose of paroxetine in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 90 mg.
- a daily dose range should be between about 5 mg to about 50 mg.
- a daily dose range should be between about 10 mg to about 40 mg.
- a daily dosage of 15, 20, or 30 mg may be preferred depending upon patient response.
- Sertraline Sertraline is a serotonin reuptake inhibitor which is marketed as an antidepressant. It is disclosed by U.S. Pat. No. 4,536,518. The therapeutic effect of sertraline is attributed to inhibition of CNS neuronal uptake of serotonin. Clinical studies in man indicate that sertraline blocks the uptake of serotonin in human platelets. In addition, in vitro studies indicate that it is a very poor inhibitor of norepinephrine and dopamine neuronal uptake.
- Sertraline is a naphthaleneamine that is generally marketed as the hydrochloride salt under the brand name ZOLOFT ® .
- Sertraline hydrochloride has the molecular formula C 1 H 1 NC1 2 » HC1 and has the chemical name (IS -cis)-4-(3 ,4-dichlorophenyl)- 1 ,2,3 ,4-tetrahydro-N-methyl- 1 - naphthalenamine hydrochloride.
- the preparation of sertraline may be carried using preparatory methods such as those described in Welch, et al. European Patent Application 30,081 and U.S. Pat. No. 4,536,518.
- the chemical structure of Sertraline hydrochloride is presented below. !
- a prophylactic or therapeutic dose of sertraline in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 500 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- a daily dose range should be between about 20 mg to about 100 mg.
- a daily dosage of 30, 50, 70, or 80 mg may be preferred depending upon patient response.
- the therapy may be initiated at a lower dose, perhaps about 10 mg to about 15 mg and increased up to about 20 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases. Additional information for sertraline hydrochloride including product information, dosage amounts, and administration is given in Physicians' Desk Reference, 48th Edition, 1994, pp. 2000-2003.
- Clomipramine Clomipramine is an antidepressent described in U.S. Pat. No. 3,467,650. hi certain instances, clomipramine may be administered in the form of a hydrochloride salt named Anafranil.
- Clomipramine has the chemical name 3-Chloro-10,l l-dihydro-N,N-dimethyl-5H- dibenz[b,f]azepine-5-propanamine. The structure of clominpramine is presented below.
- a prophylactic or therapeutic dose of clominpramine in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 300 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- a daily dose range should be between about 25 mg to about 100 mg.
- a daily dosage of 40, 60, or 80 mg may be preferred depending upon patient response.
- the therapy may be initiated at a lower dose, perhaps about 5 mg to about 10 mg and increased up to about 20 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases.
- Femoxetine Femoxetine is an antidepressant reported in U.S. patent 3,912,743.
- the chemical name for femoxetine is (3R-trans)-3-[4-Methoxyphenoxy)-methyl]-l-methyl-4-phenylpiperidine.
- femoxetine may be administered in the form of a hydrochloride salt.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- the chemical structure of femoxetine is presented below.
- Indalpine is serotonin reuptake inhibitor that may be used to treat depression. Indalpine was disclosed in U.S. Patent 4,064,255. The pharmacological activity is discussed in G. LeFur et al. Life Sci. 1978, 23, 1959 and R. Ashkenazi et al. Brit. J. Pharmacol. 1983, 79, 765 and
- indalpine can be administered as the monohydrochloride salt.
- Indalpine has the chemical name 3-[2-(4-Piperidinyl)ethyl]-lH-indole and has the structure presented below.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- Alaproclate Alaproclate is a serotonin reuptake inhibitor that has the chemical name 2-(4- chlorophenyl)- 1,1 -dimethyl 2- aminopropanoate.
- Alaproclate is administered as a hydrochloride salt.
- the size of a prophylactic or therapeutic dose in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- Cericlamine Cericlamine has the chemical name (+/-)3-(3,4-dichlorophenyl)-2-dimethylamino-2- methylpropan-1-ol. The preparation of cericlamine is described in EP 237 366, J Chem. Soc. Perkin Trans. 11996, 1495-1498, and U.S. patent 6,121,491.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- Ifoxetine Ifoxetine has the chemical name (+/-)-bis-[cis-3-hydroxy-4-(2,3-dimethyl-phenoxy)]- piperidine sulfate.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- Additional serotonin reuptake inhibitors contemplated for the instant invention include buspirone, clovoxamine, cyanodothiepin, dapoxetine, imipramine, litoxetine, lofepramine, nefazodone, norzimeldine, trazodone, venlafaxine, viqualine, and zimeldine.
- 5-HTTA_ Modulators Originally, four main subgroups of 5-HT receptors, named 5-HT l5 5-HT 2 , 5-HT 3 and 5- HT 4 , were recognized based on receptor binding profiles, the biological activity of the ligands for the receptors, and secondary messenger coupling.
- 5-HT tF 5-HT 5 , 5-HT 6 and 5-HT 7 receptors.
- the recognition that different subtypes of 5-HT exist is important for drug design because compounds which selectivity inhibit only one of the 5-HT subtypes may offer reduced side effects compared to a therapeutic agent that broadly inhibits many of the 5-HT subtypes.
- the 5-HT receptor family is comprised of the 5-HT 2 A, 5-HT B and 5-HT c receptor subtypes.
- the 5-HT 2 c receptor had been termed 5-HT ⁇ before researchers determined that it is structurally very similar to the 5-HT 2 receptors.
- the 5-HT A , 5-HT 2B and 5-HT 2C receptors are single protein molecules of 458-471 amino acids.
- 5-HT 2A receptor is located in the cortex, claustrum and basal ganglia. Biological testing in rodents revealed that stimulation or agonism of 5-HT 2A receptors causes head shaking and may mediate the effects of hallucinogens.
- 5-HT 2A modulators include compounds that are 5-HT A receptor antagonists, which block the activity of agonists and have little to no intrinsic activity on the receptor, and 5-HT 2 A inverse agonists, which are compounds that have negative intrinsic activity on the receptor.
- 5-HT 2A receptor antagonists e.g., ritanserin, have been reported to improve sleep quality.
- MDL 100.907 MDL 100,907 is a potent 5-HT 2A receptor antagonist and thus is useful for treating a variety of conditions.
- MDL 100,907 has been evaluated for the treatment of various neurological disorders, including schizophrenia. WO 99/56750 and J. Pharm. Exp. Ther. 1996, 277, 968-9881.
- MDL 100,907 has been shown to exert a tonic inhibitory influence on dopamine efflux in the medial prefrontal cortex. See European Journal of Pharmacology 1995, 273, 273-279.
- MDL 100,907 is highly selective in its activity at the 5- HT 2 A receptor compared to other receptors, and, as such, has reportedly fewer side effects.
- MDL 100,907 is useful in the treatment of sleep disorders, such as insomnia and obstructive sleep apnea. See U.S. patents 6,277,864 and 6,613,779.
- MDL 100,907 has the chemical name (+)- ⁇ -(2,3-dimethoxyphenyl)-l-[2-(4- fluorophenyl)ethyl]-4-piperidine methanol and can be prepared as described in U.S.
- the dosage range at which MDL 100,907 exhibits its ability to block the effects of serotonin at the 5-HT 2A receptor can vary depending upon the particular disease or condition being treated and its severity, the patient, the formulation, other underlying disease states that the patient is suffering from, and other medications that may be concurrently administered to the patient.
- MDL 100,907 will exhibit its serotonin 5-HT 2A antagonist properties at dosages of between about 0.001 mg/kg of patient body weight/day to about 100 mg/kg of patient body weight/day.
- Sustained release formulations may contain multiples of the foregoing dosages depending upon over what period the active ingredient is released.
- the dosage of the compounds of the present invention may be determined by administering the compound to an animal and determining the plasma level of the active ingredient.
- MDL 100,907 in the form of a prodrug.
- a prodrug is a compound that gets converted to the active drug after the compound is administered.
- Carr and coworkers have described ester derivatives of MDL 100,907 that function as prodrugs for MDL 100,907. See U.S. patents 6,028,083 and 6,063,793.
- Pro MDL 100,907 also refers to a stereoisomer or pharmaceutically acceptable salt thereof. Procedures for the preparation of Pro MDL 100,907 can be found in U.S. patents 6,028,083 and 6,063,793.
- the dosage range at which Pro MDL 100,907 exhibits its ability to block the effects of serotonin at the 5-HT A receptor can vary depending upon the particular disease or condition being treated and its severity, the patient, the formulation, other underlying disease states that the patient is suffering from, and other medications that may be concurrently administered to the patient.
- Pro MDL 100,907 will exhibit its serotonin 5-HT A modulator properties at dosages of between about 0.001 mg/kg of patient body weight/day to about 100 mg/kg of patient body weight/day.
- Sustained release formulations may contain multiples of the foregoing dosages depending upon over what period the active ingredient is released.
- the dosage of the compounds of the present invention may be determined by administering the compound to an animal and determining the plasma level of the active ingredient.
- SR 46349B SR 46349B is a highly selective antagonist of the 5-HT 2A receptor. SR 46349B has virtually no affinity for the 5-HT ⁇ A , 5-HTtB, and 5-HT ⁇ receptors, and has a moderate affinity for the 5-HT 2 c receptor.
- SR 46349B has the chemical name (1Z,2E)- l-(2-fluorophenyl)-3-(4-hydroxyphenyl)prop-2-en-l-one-O-(2-dimethyl-aminoethyl)oxime hemifumarate.
- SR 46349B can be prepared as described in EP 0373998 Bl.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient. In general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg. Preferably, a daily dose range should be between about 10 mg to about 200 mg.
- the structure of SR 46349B is presented below:
- YM992 YM 992 is an morpholine derivative described in by Takeuchi and coworkers in Ewr. J. Pharmacol. 1997, 329, 27-35.
- the chemical name of YM 992 is (S)-2-[[(7-F1UOI ⁇ -2,3- dihydro-lH-inden-4-yl)-oxy]methyl]morpholine hydrochloride.
- the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- the structure of YM 992 is presented below:
- Fananserin Fananserin is a 5-HT 2A receptor antagonist described by Doble A. and coworkers in Br. J. Pharmacol. 1992, 105, 27-36.
- the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- the structure of fananserin is presented below:
- Oxazolidine Compounds A A series of oxazolidine derivatives that have 5-HT 2A receptor-antagonizing properties are described in WO 98/38189. Methods for preparing the oxazolidine compounds are given in WO 98/38189. In general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg. Preferably, a daily dose range should be between about 10 mg to about 200 mg.
- the generic structure of the Oxazolidine Compounds A, as disclosed in WO 98/38189, is presented below. The definitions of the substituents of the generic structure can be found in WO 98/38189 which is hereby incorporated by reference.
- Phenylindole Compounds A A series of phenylindole compounds that are modulators of the human 5-HT A receptor have been described by Castro Pineiro and coworkers in U.S. patent 6,486,153. Methods for preparing the phenylindole compounds are presented in U.S. patent 6,486,153. n general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg. Preferably, a daily dose range should be between about 10 mg to about 200 mg.
- the generic structure of the Phenylindole Compounds A, as disclosed in U.S. patent 6,486,153, is presented below. The definitions of the substituents of the generic structure can be found in U. S . patent 6,486, 153 which is hereby incorporated by reference.
- Piperidinyl Compounds B A series of piperidinyl compounds that modulate the 5-HT 2 A receptor have been described in U.S. patent application 2004/0106600. Methods for preparing the piperidinyl compounds are presented in U.S. patent application 2004/0106600. In general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- the piperidinyl compound A is N- ⁇ l-[2-(l,3-Dioxolan-2- yl)ethyl]pi ⁇ eridin-4-yl ⁇ -N-(4-fluorobenzyl)-N'-(4-isobutoxybenzyl)carbamide, hydrochloride; N- ⁇ 1 -[2-(l ,3-Dioxan-2-yl)ethyl]piperidin-4-yl ⁇ -N-(4-fluorobenzyl)-2- -[4-(2-hydroxy-2- methylpropoxy)phenyl]acetamide, tartrate; N-(4-FluorobenzyI)-N-(piperidm-4-y ⁇ )-2-(4- isobutoxyphenyl)acetamide; N- ⁇ 1 -[3-(3 ,5 -Dimethylpiperidin- 1 -yl)propyl]piperidin-4-yl;
- Spiroazacyclic Compounds C A series of spiroazacyclic compounds that modulate the 5-HT 2A receptor have been described in U.S. patent application 2003/0166928. Methods for preparing the spiroazacyclic compounds are presented in U.S. patent application 2003/0166928. In general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- the generic structure of the spiroazacyclic compounds A as disclosed in U.S. patent application 2003/0166928, is presented below. The definitions of the substituents of the generic structure can be found in U.S. patent application 2003/0166928 which is hereby inco ⁇ orated by reference.
- said spiroazacyclic compound of formula C is l-oxa-4,9-diaza- spiro[5.5]undecan-3-one; l-oxa-3,8-diaza-spiro[4.5]decan-2-one; l,3,8-triaza-spiro[4.5]decan- -2-one; l,2,9-triaza-spiro[5.5]undecan-3-one; l,2,8-triaza-spiro[4.5]decan-3-one; 1,2,8-triaza- spiro[4.5]decan-3-one; l,2,4,8-tetraaza-spiro[4.5]decan-3-one; 2,4,9-triaza-spiro[-
- Azacyclic Compounds D A series of azacyclic compounds that modulate the 5-HT 2A receptor have been described in U.S. patent 6,756,393. Methods for preparing the azacyclic compounds are presented in U.S. patent 6,756,393. In general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg. Preferably, a daily dose range should be between about 10 mg to about 200 mg.
- the generic structure of the azacyclic compounds D as disclosed in U.S. patent 6,756,393, is presented below. The definitions of the substituents of the generic structure can be found in U.S. patent 6,756,393 which is hereby inco ⁇ orated by reference.
- said azacyclic compound of formula D is N-(l-(l- methylethyl)piperidin-4-yl)-N-((4-methylphenyl)methyl)-4-methoxyphe nylacetamide, N-( 1 - (2,2-dimethylethyl)piperidin-4-yl)-N-((4-methylphenyl)methyl)-4-methoxyphenylacetamide, N-(l-pentylpiperidin-4-yl)-N-((4-methylphenyl)methyl)-4-methoxyphenylacetamide, N-(l- hexylpiperidin-4-yl)-N-((4-methylphenyl)methyl)-4-methoxyphenylacetamide, N-( 1 - cyclohexylpiperidin-4-yl)-N-((4-methylphenyl)methyl)-4-methoxyphenylacetamide, N-(l- cyclopent
- Norepinephrine Reuptake Inhibitors Many compounds, including those discussed at length below, are norepinephrine reuptake inhibitors, and no doubt many more will be identified in the future. In the practice of the present invention, it is intended to include reuptake inhibitors which can be identified using the protocol described by Wong et al., Drug Development Research, 6, 397 (1985). In certain embodiments, the norepinephrine reuptake inhibitors used in the present invention are characterized in being selective for the inhibition of neurotransmitter reuptake relative to their ability to act as direct agonists or antagonists at other receptors.
- Cortical synaptosomes (equivalent to 1 mg of protein) are incubated at 37 °C for 5 minutes in 1 mL Krebs-bicarbonate medium containing also 10 mM glucose, 0.1 mM iproniazide, 1 mM ascorbic acid, 0.17 mM EDTA and 50 nM H-norepmephrme.
- the reaction mixture is immediately diluted with 2 mL of ice-chilled Krebs-bicarbonate buffer and filtered under vacuum with a cell harvester (Brandel, Gaithersburg, Md.).
- a suitable dose of a norepinephrine reuptake inhibitor or a pharmaceutically acceptable salt thereof for administration to a human will be in the range of 0.01 to 50 mg per kilogram body weight of the recipient per day, preferably in the range of 0.1 to 3 mg per kilogram body weight per day. Unless otherwise stated all weights of active ingredients are calculated in terms of drug per se.
- the desired dose is preferably presented as two, three, four, five or more sub-doses administered at appropriate intervals throughout the day. These sub- doses may be administered in unit dosage forms, for example, containing 5 to 50 mg.
- Desipramine has the chemical name 10,1 l-Dihydro-N-methyl-5H-dibenz[b,f]azepine- 5-propanamine and is described in U.S. patent 3,454,554. The pharmacology is described by P.D. Hrdina et al. iwProg. Neuropsychopharmacol 1980, 4, 591. Desipramine is generally administered as a hydrochloride salt marketed under the name No ⁇ ramin. Desipramine hydrochloride occurs as crystals which are soluble in water.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient, h general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg. Preferably, a daily dose range should be between about 10 mg to about 200 mg.
- the structure of desipramine is presented below.
- Maprotiline Maprotiline has the chemical name N-Methyl-9,10-ethanoanthracene-9(10H)- propanamine and is described in U.S. patent 3,399,201. The pharmacology is described by R. M. Pinder et al. in .Drugs 1977, 13, 321. Maprotiline is generally administered as a hydrochloride salt marketed under the name Ludiomil. Maprotiline hydrochloride occurs as crystals which are slightly soluble in water. The dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg. Preferably, a daily dose range should be between about 10 mg to about 200 mg. The structure of maprotiline is presented below.
- Lofepramine has been found clinically effective against disorders related to the central nervous system, especially mental depressions (B. Siwers et al., Europ. J. Clin. Pharmacol. 1970, 3, 12-17).
- the synthesis and biological activity of lofepramine was described in British Pat. No. 1,177,525.
- a preferred method for preparing lofepramine has been reported by E. Eriksoo and O. Rohte in Arzneiffenbachforschung 1970, 20, 1561-1569.
- this known method presents difficulties of a pronounced nature, especially when used in full-scale production. Thus, slight unintentional variations in the process conditions often result in discoloured products, which are very difficult to purify.
- Lofepramine has the chemical name 4'-chloro-2- ⁇ [3-(10,ll-dihydro-5H-dibenz(b,f)-azepinyl- (5)-propyl]-methylamino ⁇ -acetophenone and the structure is presented below.
- the size of a prophylactic or therapeutic dose of lofepramine in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 300 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- a daily dose range should be between about 30 mg to about 120 mg.
- a daily dosage of 50, 75, or 100 mg may be preferred depending upon patient response.
- the therapy may be initiated at a lower dose, perhaps about 5 mg to about 10 mg and increased up to about 20 mg or higher depending-on the patient's global response. It may be necessary to use dosages outside these ranges in some cases.
- Reboxetine Reboxetine is active on the central nervous system and has been used to treat depression, oppositional defiant disorder, attention-deficit/hyperactivity disorder, and conduct disorder. See WO 99/15163, WO 95/15176, and WO 99/15177. Reboxetine does not act like most antidepressants. Reboxetine is ineffective in the 8-OH-DPAT hypothermia test, indicating that reboxetine is not a SSRI. Brian E.
- Reboxetine is a norepinephrine reuptake inhibitor, with only marginal serotonin and no dopamine reuptake inhibitory activity. Reboxetine displays no anticholinergic binding activity in different animal models, and is substantially devoid of monoamine oxidase (MAO) inhibitory activity. Racemic reboxetine exhibits a pharmacological selectivity of serotonin (Kj)/norepinephrine (Kj) of about 80.
- Reboxetine is a safe drug, and its use in ADHD, in both adults and children, is a superior treatment for that disorder because of its improved safety.
- the compound is particularly selective, having few if any physiological effects besides those on norepinephrine processing, and therefore is free of side effects and unwanted activities. Further, it is effective at relatively low doses, as discussed below, and may safely and effectively be administered once per day. Thus, difficulties created by the multiple dosing of patients, who are children and disorganized adults, are completely avoided.
- the racemate form of reboxetine is well tolerated and has a wide safety range.
- the effective dose of reboxetine for ADHD is in the range from about 1 mg/day to about 100 mg/day.
- the preferred adult dose is in the range from about 5 to about 80 mg/day, and a more highly preferred adult dose is from about 10 to about 60 mg/day.
- the children's dose of course is smaller, in the range from about 1 to about 70 mg/day, more preferably from about 5 to about 60 mg/day and still more preferably from about 4 to about 10 mg/day.
- the optimum dose for each patient must be set by the physician in charge of the case, taking into account the patient's size, other medications which the patient requires, severity of the disorder and all of the other circumstances of the patient.
- Reboxetine was first taught by U.S. Pat. No. 4,229,449 and has the chemical name 2- [ ⁇ -(2-ethoxy) phenoxy-benzyl]mo ⁇ holine. Reboxetine is also described in 5,068,433;
- reboxetine is administered as the racemate.
- compositions containing an optically pure (S,S) reboxetine are about 5 to about 8.5 times more effective at inhibiting the reuptake of norepinephrine than compositions containing the racemic mixture of the (R,R) and (S,S) stereoisomers.
- the typical daily dosage of the racemic mixture i.e., commercially available reboxetine
- Oxaprotiline is a promosing therapeutic agent for the treatment of depression.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- Fezolamine Fezolamine has the chemical name N,N-dimethyl-3,4-diphenyl- IH-pyrazole- 1- propanamine-(E)-2-butenedioate (CAS registry number: 80410-36-2) and shows antidepressant activity.
- the therapeutic affect of fezolamine is attributed to its ability to inhibit norepinephrine reuptake.
- fezolamine was 3 to 4 fold more selective in blocking synaptosomal uptake of norepinephrine compared to serotonin or dopamine in in vitro assays. See E.R. Baizman et al. J. Pharmacol. Exp. Ther. 1987243, 40-54.
- Fezolamine also prevented the depressant effects of rese ⁇ ine and tetrabenzine in behavioral tests conducted on monamine depleted animals.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 900 mg.
- a daily dose range should be between about 10 mg to about 200 mg.
- Tomoxetine is a notably safe drug for use in adults and children for treatment of attention deficit hyperactivity disorder. It is a superior treatment for that disorder because of its improved safety. Tomoxetine is effective at relatively low doses and may safely and effectively be administered once per day.
- tomoxetine selectively inhibits norepinephrine uptake indicating that tomoxetine would be useful in treating depression.
- Tomoxetine has been administered in single oral doses up to 90 mg to humans.
- no serious drug-related adverse effects were observed when tomoxetine was administered to humans at a dosage of 20 or 40 mg b.i.d. for 7 days.
- Tomoxetine has the chemical name (R)-(-)-N-methyl-3-(2-methylphenoxy)-3- phenylpropylamine.
- the mechanism of tomoxetine's activity is attributed to its ability to inhibit norepinephrine reuptake. See Gehlert, et al.
- Tomoxetine is quite active in that function, and moreover is substantially free of other central nervous system activities at the concentrations or doses at which it effectively inhibits norepinephrine reuptake. Thus, it is quite free of side effects and is properly considered to be a selective drug. Tomoxetine is usually administered as the hydrochloride salt.
- the effective dose of tomoxetine for ADHD is in the range from about 5 mg/day to about 100 mg/day.
- the preferred adult dose is in the range from about 10 to about 80 mg/day, and a more highly preferred adult dose is from about 20 to about 60 mg/day.
- the children's dose of course is smaller, in the range from about 5 to about 70 mg/day, more preferably from about 10 to about 60 mg/day and still more preferably from about 10 to about 50 mg/day.
- the optimum dose for each patient must be set by the physician in charge of the case, taking into account the patient's size, other medications which the patient requires, severity of the disorder and all of the other circumstances of the patient. Since tomoxetine is readily orally absorbed and requires only once/day administration, there is little or no reason to administer it in any other way than orally. It may be produced in the form of a clean, stable crystal, and thus is easily formulated in the usual oral pharmaceutical forms, such as tablets, capsules, suspensions, and the like. The usual methods of pharmaceutical scientists are applicable.
- (S, S)-hydroxybupropion (S,S)-hydroxybupropion is a metabolite of bupropion that selectively inhibits norepinephrine reuptake and does not significantly inhibit dopamine reuptake. Methods for the preparation of (S,S)-hydroxybupropion are described in U.S. patent 6,342,496.
- (S,S)- hydroxybupropion has the chemical name (S,S)-2-(3-chlorophenyl)-2-hydroxy-3,5,5-trimethyl- moipholinol and the structure is given below.
- the present invention contemplates the use of norepinephrine reuptake inhibitors in general, including nortriptyline, maprotiline, protriptyline, trimipramine, venlafaxine, amitriptyline, amoxapine, doxepin, nefazodone, and lamotrigine.
- Dopamine Reuptake Inhibitors A large number of dopamine reuptake inhibitors are known in the art and are amenable to the present invention. Dopamine reuptake inhibitors can be identified using the rat co ⁇ us striatum assay described in US Patent Application 20040180857, which is hereby inco ⁇ orated by reference.
- a dose of a dopamine reuptake inhibitor or a pharmaceutically acceptable salt thereof suitable for administration to a human will be in the range of 0.01 to 50 mg per kilogram body weight of the recipient per day, preferably in the range of 0.1 to 3 mg per kilogram body weight per day. Unless otherwise stated all weights of active ingredients are calculated in temis of drug per se.
- the desired dose is presented as two, three, four, five or more sub-doses administered at appropriate intervals throughout the day. These sub-doses may be administered in unit dosage forms, for example, containing about 5 to 50 mg.
- Amineptine Amineptine is a synthetic, atypical tricyclic antidepressant with central nervous system stimulating effects.
- Amineptine is an indirect dopamine agonist, selectively inhibiting dopamine uptake and inducing dopamine release, with additional stimulation of the adrenergic system. Its antidepressant effects are similar to other tricyclic antidepressant drugs but it has a more rapid action, is better tolerated and has little cardiovascular, analgesic or anorectic effects. It produces a similar spectrum of pharmacological effects to psychomotor stimulants in Schedule II of the 1971 Convention on Psychotropic Substances. Recently, the use of amineptine in the treatment of depression has been described by S.M. Channabasavanna et al. in Indian Journal of Psychiatry 1997, 39, 147-53.
- Bupropion Bupropion is marketed under the tradename WELLBUTRIN ® by GlaxoSmithKline for the treatment of depression. In certain instances, bupropion is administered as its hydrochloride salt.
- WELLBUTRIN ® (bupropion hydrochloride), is an antidepressant of the aminoketone class, is chemically unrelated to tricyclic, tetracyclic, selective serotonin reuptake inhibitor, or other known antidepressant agents. Its structure closely resembles that of diethylpropion; it is related to phenylethylamines.
- Bupropion is a novel, non-rricyclic antidepressant with a primary pharmacological action of monoamine uptake inhibition.
- the drug resembles a psychostimulant in terms of its neurochemical and behavioural profiles in vivo, but it does not reliably produce stimulant-like effects in humans at clinically prescribed doses.
- Bupropion binds with modest selectivity to the dopamine transporter, but its behavioural effects have often been attributed to its inliibition of norepinephrine uptake.
- the neurochemical mechanism of the antidepressant effect of bupropion is not known.
- Bupropion is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotonin, and dopamine, and does not inhibit monoamine oxidase. Bupropion produces dose-related central nervous system (CNS) stimulant effects in animals, as evidenced by increased locomotor activity, increased rates of responding in various schedule-controlled operant behavior tasks, and, at high doses, induction of mild stereotyped behavior.
- CNS central nervous system
- peak plasma bupropion concentrations are usually achieved 5 within 2 hours, followed by a biphasic decline.
- the terminal phase has a mean half-life of 14 hours, with a range of 8 to 24 hours.
- the distribution phase has a mean half-life of 3 to 4 hours.
- the mean elimination half-life ( ⁇ SD) of bupropion after chronic dosing is 21 ( ⁇ 9) hours, and steady-state plasma concentrations of bupropion are reached within 8 days.
- Plasma bupropion concentrations are dose-proportional following single doses of 100 to 250 mg.
- a recent experiment examined monoaminergic involvement in the discriminative stimulus effects of bupropion (Katz, T.P. Psychopharmacology (Berl) 1997, 134(2), 201-12). Rats were trained to press one lever when injected i.p.
- GBR-12935 is a dopamine reuptake inhibitor described by A. R. Burkeyl and coworkers in J. ofNeuroscience 1999, 19, 4169-4179. Its chemical name is l-[2- (diphenylmethoxy)ethyl]-4-(3-phenylpropyl)piperazine dihydrochloride.
- Venlafaxine EFFEXOR®
- Venlafaxine is dopamine reuptake inhibitor. Its hydrochloride salt is marketed under the tradename EFFEXOR® and used in the treatment of bipolar disorder. It has the chemical names ( ⁇ )-l-[2-(dimethylamino)-l-(4-methyoxyphenyl)ethyl]cyclohexanol; N,N-dimethyl-2-
- Venlafaxine is a representative of a new class of antidepressants (SNRIs) which inhibit selectively the uptake of serotonin and noradrenaline, but—in contrast to tricyclics—show no affinity for neurotransmitter receptors.
- SNRIs antidepressants
- 2 ⁇ -Provanoyl-3 ⁇ -(4-tolyl)-tropane (PTT) 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane or 3 ⁇ -(4-(l-methylphenyl)-8-azabicyclo[3.2.1] octane are also known as PTT.
- GABA GABA Receptor Modulating Agents ⁇ -Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian central nervous system. Receptors for GABA have traditionally been divided into GABA A and GABA B receptor subtypes.
- the GABAA receptor is the more prominent GABA receptor subtype, and is a ligand-gated chloride ion channel that is opened after release of GABA from presynaptic neurons.
- the GABA B receptor is a member of the G protein-coupled receptor family coupled both to biochemical pathways and to regulation of ion channels. See Goodman and Gihnan's The Pharmacological Basis of Therapeutics, McGraw-Hill, New York, N.Y., 9 th Edition, (1996) and Kerr, D. I. B. and Ong, J. Pharmac. Ther. 1995, 67, 187-246.
- GABA By gating negative chloride ions into the interior of cells, GABA inhibits the presynaptic release of neurotransmitter due to a positive voltage polarization pulse. This form of inhibition is extremely common.
- GABA receptors can be found in 60-80% of central nervous system neurons. Subtypes of GABA receptors can be activated by the mushroom toxin muscimol (at GABA A ) as well as the antispasmodic amino acid baclofen (GABA B ). These compounds directly mimic the action of GABA at the receptor. Allosteric facilitation of GABA receptors occurs at several distinct sites; compounds that bind there are used as sedatives and anxiolytics.
- a characteristic property of GABA A receptors is the presence of a number of modulatory sites, one of which is the benzodiazepine (BZ) binding site.
- the BZ binding site is the most explored of the GABA A -receptor modulatory sites, and is the site through which anxiolytic drugs such as temazepam exert their effect.
- the benzodiazepine binding site was historically subdivided into two subtypes, BZ1 and BZ2, on the basis of radioligand binding studies.
- the BZ1 subtype has been shown to be pharmacologically equivalent to a GABA A -receptor comprising the ⁇ l-subunit in combination with a ⁇ -subunit and ⁇ 2.
- a dose of the GABA- receptor modulating agent or a phannaceutically acceptable salt thereof suitable for administration to a human will be in the range of 0.01 to 50 mg per kilogram body weight of the recipient per day, preferably in the range of 0.1 to 3 mg per kilogram body weight per day. Unless otherwise stated all weights of active ingredients are calculated in terms of drug per se.
- the desired dose is presented as two, three, four, five or more sub-doses administered at appropriate intervals throughout the day. These sub-doses may be administered in unit dosage forms, for example, containing about 5 to 50 mg.
- GABA Binding Assay The affinity of a compound to bind to a GABA receptor can be measured using procedures known in the art.
- assay kits for determining GABA-receptor binding affinity can be purchased from MDS Pharma Services. For representative examples of procedures to determine GABA-receptor binding affinity see Enna, S. J.; Snyder, S.H. Mol.
- the cellpellets were resuspended in Krebs-tris buffer and homogenized by polytron for ca. 15 sec on ice. Aliquots of 1 mL are prepared, protein is measured (Bradford method) and the resulting membrane aliquots were stored at -70 °C. Radioligand binding assays are carried out in a volume of 200 ⁇ L (96-well plates) which contained 100 ⁇ L of cells, [ 3 H]flumazenil at a concentration of 1 nM for ⁇ l ⁇ 2 ⁇ 3 subunits and 0.5 nM for ⁇ 5 subunits and the test compound in the range of 10 "10 to 3xl0 "6 M.
- nonspecific binding is defined by 10 "5 M diazepam.
- Assays are incubated to equilibrium for 1 hour at 4 °C and harvested onto GF/C uni-filters (Packard) by filtration using a Packard harvester and washing with ice-cold wash buffer (50 mM Tris; pH 7.5). After drying, filter-retained radioactivity was detected by liquid scintillation counting. Kj values are calculated using Excel-Fit (Microsoft) and are the means of two determinations.
- GABA Receptor Modulating Compounds or Agents A large number of compounds are known to bind to the GABA receptor and modulate the activity of the receptor. Modulation of the GABA receptor can be agonistic or antagonistic. The compound can bind to any part of the GABA receptor sufficient to modulate the activity of the receptor. In certain instances, the GABA-receptor modulating compound binds to a
- the GABA-receptor modulating compound binds to a GABA B receptor.
- the GABA-receptor modulating compound has a Kj of less than about 750 nM in a GABA-receptor binding assay.
- the GABA-receptor modulating compound has a Kj of less than about 500 nM in a GABA-receptor binding assay.
- the GABA-receptor modulating compound has a Kj of less than about 250 nM in a GABA-receptor binding assay.
- the GABA-receptor modulating compound has a Kj of less than about 100 nM in a GABA-receptor binding assay. In certain embodiments, the GABA-receptor modulating compound has a Kj of less than about 75 nM in a GABA-receptor binding assay. In certain embodiments, the GABA-receptor modulating compound has a Kj of less than about 50 nM in a GABA-receptor binding assay. In certain embodiments, the GABA-receptor modulating compound has a Kj of less than about 25 nM in a GABA-receptor binding assay.
- the GABA-receptor modulating compound has a K; of less than about 15 nM in a GABA-receptor binding assay.
- said GABA-receptor binding assay is a GABA A - receptor binding assay.
- said GABA-receptor binding assay is a
- GABAA-agonist receptor binding assay In certain embodiments, said GABA-receptor binding assay is a GABA A -antagonist receptor binding assay. In certain embodiments, said GABA- receptor binding assay is a GABA A -benzodiazepine receptor binding assay. In certain embodiments, said GABA-receptor binding assay is a GABA B -receptor binding assay. In certain embodiments, said GABA-receptor binding assay is a GABA ⁇ -agonist receptor binding assay.
- compounds known in the art that modulate the activity of the GABA receptor are amenable to the present invention. Accordingly, GABA analogs with phannaceutical activity have been synthesized and described in U.S. Patents 4,024,175; 5,563,175; 6,020,370; 6,028,214; 6,103,932; and 6,117,906; and International Patent
- Racemic Zopiclone Zopiclone is the first of a chemically distinct class of hypnotic and anxiolytic compounds that offers a psychotherapeutic profile of efficacy and side effects similar to the benzodiazepines.
- This class of compounds, the cyclopynolones appears to cause less residual sedation and slowing of reaction times than the benzodiazepines, and it offers the promise of an improved therapeutic index over benzodiazepines.
- the pharmacology of zopiclone has been shown both preclinically and clinically to be characterized by five distinct elements. It is predominantly a hypnotic-sedative, offering significant activity on first treatment in the absence of respiratory or cardiac depression.
- zopiclone is an anticonvulsant, and it further exhibits muscle relaxant, anti- aggressive, and anxiolytic activities.
- the compound binds to the benzodiazepine receptor complex, or to a site linked closely to this receptor complex.
- the central benzodiazepine receptor is a macromolecular complex that includes a site for the binding of gamma-aminobutyric acid (GABA), the inhibitory neurotransmitter, suggesting that benzodiazepines and chemically unrelated agonists including zopiclone may exert their effects by facilitating the synaptic effects of GABA. While it interacts with the benzodiazepine receptor, zopiclone apparently has minimal effects on memory, no interaction with alcohol, and little or no abuse or dependence potential. The pharmacologic activity of zopiclone is predominantly that of a sedative or hypnotic, particularly at low doses.
- GABA gamma-aminobutyric acid
- the drug may improve sleep in adults and geriatric patients with several types of sleep disorders, and situational, transient, primary, and secondary insomnia.
- zopiclone Following a bedtime dose of zopiclone, there is minimal impairment of psychomotor skills and mental acuity the following morning.
- the drug is well absorbed from the stomach, and it is not highly bound to plasma proteins.
- the racemic mixture of zopiclone is presently used outside the United States primarily as an hypnotic, improving sleep patterns in chronic insomniacs and providing sleep induction before surgical procedures in hospitalized patients.
- Insomnia is characterized by difficulty in sleeping or disturbed sleep patterns. Insomnia may be of a primary nature with little apparent relationship to immediate somatic or psychic events, or secondary to some acquired pain, anxiety or depression.
- hypnotic medication such as zopiclone is generally reserved for insomnia of emotional disturbances and for refractory cases due to more common causes.
- zopiclone provides sedative-hypnotic effects from the first day of treatment, an activity that is maintained following subsequent doses over long treatment periods. There appears to be no diminution or potentiation of activity in adult or geriatric patients, and little or no effect on alertness and performance some ten hours following the bedtime dose. (Brun, J. P. Pharmacology, Biochemistry and Behavior 1988, 29, 831-832).
- the racemic mixture of zopiclone may be useful in treating other disorders such as convulsive states like epilepsy.
- Seizure disorder or epilepsy represents a broad group of central nervous system disorders of function that are characterized by recurrent, sudden, often brief attacks, which may alter consciousness, motor activity, sensory phenomena, and autonomic responses, and which may prompt inappropriate behavior.
- Recurrent seizure patterns of either an idiopathic or symptomatic etiology are termed epilepsy.
- the most common form of these recurrent but transient episodes are convulsive seizures, which may include loss of consciousness, motor function and control, and which may produce tonic or clonic jerking of the extremities.
- Pharmacological treatment of epilepsy has been directed to control based on seizure type, rather than etiology.
- the convulsions have been grouped in broad but rather distinct types including Tonic-clonic (Grand Mai), Partial (Focal) seizures, psychomotor (Complex partial) seizures, pyknoepileptic or Absence (Petit Mai) and the less frequent Myoclonic seizures.
- Tonic-clonic Gram Mai
- Partial Fluorescence-activated seizures
- psychomotor Complex partial
- pyknoepileptic or Absence Pieris
- Myoclonic seizures Myoclonic seizures.
- the binding of zopiclone at or near the benzodiazepine receptor complex suggests that the compound may facilitate the inhibitory action of the neurotransmitter GABA and therefore its synaptic effects.
- benzodiazepine receptors which can be located both within the central nervous system and peripherally (e.g., in the endocrine system), are comprised of macromolecular complexes characterized by sites for binding of the benzodiazepines, GABA, and zopiclone.
- the benzodiazepine receptor complex is further associated with, and interacts with, a transmembrane channel for chloride ion transport.
- the effect of zopiclone's interaction with the benzodiazepine receptor/GABA receptor/chloride channel complex is to cause GABA to inhibit cerebral neuronal discharge, presumably by increasing membrane conductance of chloride ion, thus stabilizing membrane potentials and dampening excitatory input.
- zopiclone may be useful in treating epilepsy and a number of other conditions in which GABA is believed to exert a physiologic role. While the racemic mixture of zopiclone may be useful in the treatment of the above- described disorders, it has a low therapeutic index and also causes adverse effects. These adverse effects include, but are not limited to, the development of a bitter taste due to the salivary secretion of the drug, dry mouth, drowsiness, morning tiredness, headache, dizziness, impairment of psychomotor skills and related effects.
- Eszopiclone (or (+)-Zopiclone or (S)-zopiclone) is a potent drug useful for the treatment of sleep disorders, convulsive disorders, and disorders that are affected by the binding of agonists to central nervous system or peripheral benzodiazepine receptors.
- Administration of isomerically pure or substantially isomerically pure (e.g., 90%, 95%, or 99% isomeric purity) (+)-zopiclone is generally preferred because this isomer possesses potent activity in treating sleep disorders while avoiding adverse effects including but not limited to drowsiness, next day effects, such as tiredness in the morning, inability to concentrate and headache.
- Eszopiclone is a cyclopyrrolone that has the chemical name (+) 6-(5-chloro-pyri-2-dyl)- 5-(4-methylpiperazin-l-yl) carbonyloxy-7-oxo-6,7-dihydro-5H-pyrrolo[3-4b]pyrazin or (+) 6- (5-chloro-2-pyridinyl)-6,7-dihydro-7-oxo-5H-pyrrolo[3,4b]pyrazin-5-yl 4-methylpiperazine-l- carboxylate.
- the chemical structure of zopiclone is shown below:
- Eszopiclone is an optical isomer, the (+)-isomer, of the compound zopiclone, which is described in US Patents 6,319,926 and 6,444,673, and in Goa and Heel, [Drugs, 32:48-65 (1986)] and in U.S. Pat. Nos. 3,862,149 and 4,220,646.
- This isomer which will hereinafter be referred to as eszopiclone, includes optically pure and the substantially optically pure (e.g., 90%, 95% or 99% optical purity) (+)-zopiclone isomer.
- Racemic zopiclone is commercially available and can be made using various methods, such as those disclosed in U.S. Pat. Nos.
- Eszopiclone maybe prepared from racemic zopiclone using standard methods, such as chiral-phase chromatography, resolution of an optically active salt, stereoselective enzymatic catalysis by means of an appropriate microorganism, or asymmetric synthesis.
- U.S. Pat. No. 6,319,926 discloses methods for making eszopiclone, including resolution from racemic zopiclone by means of an optically active acid, such as D(+)-O,O'-dibenzoyltartaric acid.
- Another method for making eszopiclone (or (S)-zopiclone) is by synthesis from racemic zopiclone (or (RS)-zopiclone) by chemical resolution via the D-malate salt as shown in the following synthesis schematic.
- this stage of the process may also include cooling the reaction mixture during the isolation step to a temperature in the inclusive range of about 10°C to 15°C, and washing or rinsing the wet cake obtained after filtration with cold solvent, such as cold methanol.
- the resulting (S)-zopiclone D-malate salt is converted to optically pure eszopiclone free base by treatment "with aqueous potassium carbonate and ethyl acetate, followed by phase separation and crystallization.
- additional enantiomeric enrichment typically 1 to 4%) can be achieved by crystallization from ethyl acetate of low water content.
- the water content can be controlled, e.g., by azeotropic distillation, and inco ⁇ orating an in-process control of water content into the crystallization process can further improve the robustness of enantiomeric purity.
- the water level during this step is 2% or less, more preferably 1% or less, and most preferably 0.6% or less.
- the resulting optically pure eszopiclone free base can then be milled to a desired size for use as an active ingredient in a pharmaceutical composition according to or for use in methods of the present invention.
- This two-stage process is depicted in the diagrams of Figures 1 and 2.
- Eszopiclone possess potent activity in treating sleep disorders such as insomnia.
- Eszopiclone also possess potent activity in treating sleep disorders while avoiding the usual adverse effects including but not limited to drowsiness, next day effects tiredness in the morning, inability to concentrate and headache, which are associated with the administration of the racemic mixture of zopiclone.
- Eszopiclone also possess potent activity in treating convulsive disorders such as epilepsy while avoiding the adverse effects which are associated with the administration of the racemic mixture of zopiclone.
- compositions containing optically pure eszopiclone are useful in treating disorders that are affected by the binding of agonists to central nervous system and peripheral benzodiazepine receptors. Such disorders include but are not limited to aggressive behavior, muscle tension, behavioral disorders, depression, schizophrenia, and disorders associated with abnormal plasma hormone levels such as endocrine disorders. These compositions are useful in treating disorders that are affected by the binding of agonists to central nervous system and peripheral benzodiazepine receptors.
- a prophylactic or therapeutic dose of eszopiclone in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 0.25 mg to about 15 mg.
- a daily dose range should be between about 0.5 mg to about 10 mg.
- a daily dose range should be between about 1.0 mg to about 5.0 mg.
- the therapy may be initiated at a lower dose, perhaps about 0.5 mg to about 3 mg and increased up to about 5 mg or higher depending-on the patient's global response.
- a suitable dosage range for use is from about 0.25 mg to about 15.0 mg with, in the usual case, the lower doses serving more common insomnia, and the higher doses, presented in divided dosing, reserved for control of psychiatric disorders.
- a dose range of between about 0.5 mg to about 10 mg is given as a once daily administration or in divided doses if required; most preferably, a dose range of from about 1.0 mg to about 5 mg is given, either as a once daily administration or in divided doses if required.
- Patients may be upward titrated from below to within this dose range to a satisfactory control of symptoms as appropriate.
- the pharmacologic profile of hypnotic-sedative agents of the benzodiazepine class has been rather well established (Goodman and Gilman: The Pharmacological Basis of Therapeutics, 7th. Edition, Chapt.
- zopiclone can be used to characterize the various activities of zopiclone, its anticonvulsant, myorelaxant, anti- aggressive, and sedative-hypnotic activities.
- activity of a pharmaceutical composition comprising zopiclone can be compared and contrasted with such pharmacologic standards as nitrazepam and diazepam, two benzodiazepine agents, in a variety of animal models.
- the dose (mg/kg) of each agent that is capable of inhibiting by 50% (the ID 50 or ED 50 ) an induced response in rodents, for example, provides the basis for comparison.
- pentylenetetrazole-induced convulsions picro toxin convulsions, and electrically-induced convulsions can be used to demonstrate the anti-convulsant activity of zopiclone (Haefely, W., Psychotropic Agents, eds. Hofrneister, F. and Stille, G., Springer Verlag, Berlin, Part 11, 12-262, (1981)).
- zopiclone Haefely, W., Psychotropic Agents, eds. Hofrneister, F. and Stille, G., Springer Verlag, Berlin, Part 11, 12-262, (1981)
- daily electrical stimulation of the amygdala induces a progressive increase of epileptic afterdischarge duration, with increasing epileptic behavioral symptoms, producing in some two weeks a generalized convulsive crisis.
- Indiplon is a potent sedative, anxiolytic and anti-convulsant agent, and possesses an improved profile of side effects, as compared to other benzodiazepine agents.
- Indiplon shows a reduced tolerance to sedation, a lowered potential for abuse and a reduced tendency to potentiate the deleterious effects of ethanol.
- Indiplon appears to be substantially devoid of next-day hangover effects and to have a considerably reduced amnesic potential compared to currently marketed sedative-hypnotic agents.
- the half-life of indiplon in vivio is approximately 1.3 hours.
- Indiplon occurs as an off-white to yellow, non-free flowing powder with little static charge.
- the compound is lipid soluble (log D partition coefficients.73), and is soluble in water at approximately 20-30 .mu.g/mL w ⁇ fh a resulting pH of approximately 8.0.
- Indiplon may be prepared using chemical synthesis techniques known to those skilled in this field. For example, Indiplon may generally be made by the synthetic procedures disclosed in U.S. Pat. Nos. 4,521,422 and 4,900,836. These patents, particularly U.S. Pat. No.
- 4,521,422 disclose a genus encompassing certain aryl and heteroaryl[7-(aryl and heteroaryl)-pyrazolo[l,5- a]pyrimidin-3-yl]methanones.
- the size of a prophylactic or therapeutic dose of Indiplon in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 75 mg.
- a daily dose range should be between about 5 mg to about 50 mg.
- a daily dose range should be between about 10 mg to about 35 mg. In certain embodiments, the daily dose range should be about 10, 25, 30, or 35 mg.
- the therapy may be initiated at a lower dose, perhaps about 2 mg to about 5 mg and increased up to about 10 mg or higher depending-on the patient's global response.
- the mean plasma half-life of a sedative-hypnotic compound may be determined using well known techniques. Terminal half-life may be determined using standard pharmacokinetic calculations, such as those presented by Rolland and Tozer (Clinical Pharmacokinetics Concepts and Applications, 3 rd Ed., Chap. 3, 1995). in addition, software is commercially available which performs this calculation, such as the product sold under the tradename
- WinNinlinTM Prof. Ver. 1.5
- a sedative-hypnotic effect of a compound may be readily established using, for example, standard tests that monitor the effects of a drug on motor activity, muscle relaxation and motor coordination (see, e.g., Beer et al., CNS Drag Reviews 3:207-224, 1997; Sanger et al., Eur. J. Pharmacol. 313:35-42, 1996, and references cited therein).
- a sedative- hypnotic compound should have a statistically significant sedative effect within at least one, and preferably all, of the following assays: (a) assays to detect a reduction in locomotor activity, as described by Sanger et al., European J Pharmacol.
- Zolpidem is a hypnotic agent that is known to induce or maintain sleep.
- Zolpidem is an imidazopyridine having IUPAC chemical nomenclature N,N,6-trimethyl-2-(4-methylphenyl)- imidazo[l,2-s]pyridine-3 -acetamide. The structure of zolpidem is presented below.
- zolpidem free base was disclosed generically in EP 50563 of Synthelabo.
- Zolpidem tartrate was subsequently disclosed in EP 251859 (U.S. Pat. No. 4,794,185). More recently, zolpidem has been suggested as useful in treating Parkinson's disease, parkinsonian symptoms, obsessive-compulsive disorder and certain forms of dementia in U.S. Pat. No. 5,891,891.
- Zolpidem has been marketed as an immediate release tablet for oral application under the trade marks AMBIEN ® and STILNOX ® .
- zolpidem is present as a salt with L(+)tartaric acid wherein the molar ratio of zolpidem to tartaric acid is 2:1.
- This salt is conventionally called zolpidem hemitartrate but a more correct denomination thereof, which will be used hereinafter, is zolpidem tartrate.
- the European Pharmacopoeia, Monograph No. 1999: 1280 states that zolpidem tartrate is characterized as a white or almost white crystalline powder, hygroscopic, slightly soluble in water, sparingly soluble in methanol, and practically insoluble in methylene chloride.
- Commercially available zolpidem tablets are conventional film coated tablets for immediate release of the active substance after ingestion and they contain 5 or 10 mg of zolpidem tartrate.
- the inactive ingredients are: lactose, microcrystalline cellulose, sodium starch glycolate, hydroxypropylmethylcellulose and magnesium stearate.
- the film coating layer consists of hydroxypropylmethylcellulose, polyethylene glycol and colorants.
- Zolpidem is generally administrated orally by means of a tablet or other solid dosage form. Indeed pharmacokinetic and pharmacodynamic data show that zolpidem has both a rapid abso ⁇ tion and onset of hypnotic action. Its bioavailability is 10% following oral administration and demonstrates linear kinetics in the therapeutical dose range, which lies between 5 and 10 mg in conventional forms, peak plasma concentration is reached at between 0.5 and 3 hours, the elimination half-life is short, with a mean of 2.4 hours and a duration of action of up to 6 hours. Generally, the dosage of zolpidem is between 1 and 50 mg.
- the toxicity of a compound can be determined on mice by intraperitoneal administration using LD 50 ranges from 500 to 1,000 mg/kg.
- the anxiolytic activity can be determined according to the eating test (R. J. Stephens, (1973), Brit. J. Pharmac, 49, 146 P). hi this test, the doses which increases the food consumption of the mice vary from 0.1 to 10 mg/kg, administered intraperitoneally.
- the activity of the compounds in the area of cerebral circulation can be determined in the test for the hypoxia caused by pressure reduction. Mice of the CD1 strain are kept in an oxygen-depleted atmosphere produced by creating a partial vacuum (190 mm of mercury, corresponding to 5.25% of oxygen). The survival time of the animals is noted.
- This time is increased by agents which are capable of assisting the oxygenation of tissues and in particular of the brain.
- the compounds studied are administered intraperitoneally in several doses, 10 minutes before the experiment.
- the percentage increases in the survival time, relative to the values obtained for control animals, are calculated.
- the mean active dose (MAD) that is to say the dose which increases the survival time by 100%, is determined graphically.
- the anticonvulsant activity can be determined in accordance with the test for the antagonism towards the mortality induced by bicuculline in mice (P. Worms, H. Depoortere and K. G. Lloyd, (1979) Life Sci., 25, 607-614).
- the products to be studied are injected intraperitoneally, 30 minutes before the bicuculline (0.9 mg/kg, administered intravenously).
- the percentage mortalities are noted for each batch, 2 hours after administration of the bicuculline (control batch: 100% mortality).
- the 50% active dose (AD 50 or the dose which protects 50% of the animals from the lethal effects of the bicuculline) is determined graphically.
- the sedative or hypnotic activity can be determined by observing the action of the compounds on the EEG of curarised rats and also on the wake-sleep states in freely moving, implanted rats and cats (H. Depoortere, Rev. E.E.G. NeurophysioL, (1980) 10, 3, 207-214; L. M. Da Costa, H. Depoortere and R. Naquet, Rev. E.E.G.
- the products to be studied are inj ected intraperitoneally or orally at doses increasing from 0.1 to 30 mg/kg.
- the products to be studied were injected intraperitoneally or orally at a single dose ranging from 1 to 10 mg/kg.
- the products to be studied were injected intraperitoneally or orally at a single dose of 10 mg/kg.
- the results of these various tests can be used to determine the anti-anoxic, sleep- inducing, hypnotic and anticonvulsant properties of a pharmaceutical composition.
- Zaleplon Zaleplon (Wyeth-Ayerst), also known as "Sonata", is a nonbenzodiazipine recently approved by the FDA as sedative-hypnotic (see U.S. Pat. No. 4,626,538).
- Zaleplon is a pyrazolopyrimidine that has the chemical name N-[3-(3-cyanopyrazolo[l,5-a]pyrimidin-7- yl)phenyl]-N-ethylacetamide.
- Zaleplon is a white powder that has very low solubility in water and limited solubility in alcohol or propylene glycol. The structure of Zaleplon is given below.
- Zaleplon binds to the gamma-aminobutyric acid benzodiazepine (GABA-BZ) receptor complex. Binding studies have revealed that Zaleplon binds selectively to the brain omega- 1 receptor located on alpha subunit of the GABA A /chloride ion channel receptor complex. This interaction modulates the binding of t-butylbicyclophosphorothionate binding. Importantly, the pharmacological properties of benzodiazepines, e.g. sedative, anxiolytic, muscle relaxant, and anticonvulsive effects in animals, are linked to modulation of the GABA-BZ receptor chloride channel complex.
- GABA-BZ gamma-aminobutyric acid benzodiazepine
- Zaleplon The pharmacokinetic profile of Zaleplon has been investigated in trials using a 60 mg single dose and once-daily administration of a 15 or 30 mg dose for up to 10 days. The data indicate that pharmacokinetics are proportional to the dose throughout the therapeutic range.
- Zaleplon does not accumulate in once-daily administration treatment regimes. Zaleplon is rapidly absorbed when administered orally; however, Zaleplon is subject to substantial presystemic metabolism resulting in only 30% bioavailability. The majority of the metabolism is attributed to an aldehyde oxidase which converts Zaleplon to 5-oxo-Zaleplon. Consequently, peak plasma concentrations following oral administration typically occur 1 hour after admimstration.
- a prophylactic or therapeutic dose of Zaleplon in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 50 mg.
- a daily dose range should be between about 1 mg to about 25 mg.
- a daily dose range should be between about 5 mg to about 20 mg. In certain embodiments, the daily dose range should be about 5, 10, 15, or 20 mg.
- the therapy may be initiated at a lower dose, perhaps about 2 mg to about 5 mg and increased up to about 10 mg or higher depending-on the patient's global response.
- Zaleplon should be taken just prior to bedtime or immediately if a patient the patient has already gone to bed is having difficulty falling asleep.
- the dose of Zaleplon should be adjusted in accord with diet or special needs of the patient.
- the dosage of Zaleplon should be approximately 5 mg for elderly or debilitated patients whom are likely to be particularly sensitive to hypnotic medications .
- patients suffering from mild to moderate hepatic impairment should be administered only a 5 mg dose because systemic removal of drag is reduced in such patients.
- Gaboxadol is a GABA-receptor agonist that has been shown to improve sleep-quality in both human and animal studies. Procedures for the preparation of gaboxadol have been described. U.S. Patent 4,278,676; and P. Krogsgaard-Larsen, Acta. Chem. Scand. 1977, 31, 584.
- Gaboxadol also known as THIP, is a crystalline, colorless solid that is soluble in water and methanol. The chemical name for gaboxadol is 4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridin- 3-ol.
- Gaboxadol is known to exist in two isomeric forms (Form A and Form B, shown below) and the term "gaboxadol" as used herein encompasses both forms separately, a mixture comprising both isomeric forms, and the pharmaceutically acceptable salts of any of them.
- gaboxadol The GABA-receptor binding affinity and pharmacological properties of gaboxadol have been described.
- U.S. Patent 4,278,676 In order to study the interactions of gaboxadol with the central GABA receptors in vitro, gaboxadol was tested in affinity binding experiments. See S.J. Enna and S.H. Snyder, Brain Res. 1975, 100, 81-97.
- the IC 50 value of gaboxadol was determined to be 0.13 ⁇ 0.005 ⁇ M based on experiments using five different concentrations of gaboxadol. Each experiment was conducted in triplicate and the IC 50 value was determined by logprobit analysis.
- gaboxadol was tested in microelectrophoretic experiments. See U.S. Patent 4,278,676. Experiments were performed on lumbar dorsal horn intemeurones and Renshaw cells of cats anaesthetized with pentobarbitone sodium. Gaboxadol -was found to be relatively more potent than GABA on the basis of electrophoretic currents required to produce equal and submaximal inhibitions of the firing of the central neurones. The inhibitory action of gaboxadol on central neurones was reversibly antagonized by the specific GABA antagonist bicuculline methochloride (BMC).
- BMC bicuculline methochloride
- gaboxadol did not interact with the GABA uptake system at concentrations of 5 x 10 4 M, and it did not interact with the GABA metabolizing enzymes GABA:2-oxo-glutarate aminotransferase and L-glutamate 1-carboxylase at concentrations of 10 "3 M.
- GABA:2-oxo-glutarate aminotransferase and L-glutamate 1-carboxylase at concentrations of 10 "3 M.
- gaboxadol is a specific and very potent GABA agonist.
- the hydrobromide salt of gaboxadol has a LD 50 (mg/kg) of 80 (i.v.), 145 (i.p.), and >320 (p.o.) in mice, h comparison, muscimol has a LD 50 (mg/kg) of 7 (i.v.), 12 (i.p.), and 22 (p.o.) in mice.
- LD 50 mg/kg
- Several studies have verified that gaboxadol can improve sleep quality. Lancel and coworkers conducted a double-blind, placebo-controlled study in healthy, elderly patients which revealed that oral administration of gaboxadol can increase sleep consolidation and the intensity of non-REM sleep. See Lancel, M.; Wetter, T.
- a prophylactic or therapeutic dose of gaboxadol will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 90 mg.
- a daily dose range should be between about 2 mg to about 40 mg.
- a daily dose range should be between about 5 mg to about 30 mg.
- the daily dose range should be about 10, 15, 20, or 25 mg.
- Baclofen Baclofen is a GABA-receptor agonist that has the chemical name ⁇ -(aminomethyl)-4- chlorobenzenepropanoic acid. Procedures for the preparation of baclofen are described in U.S.
- Patent 3,471,548 The pharmacological properties are described in Hudgson, Weightman Brit.
- baclofen is presented below.
- a prophylactic or therapeutic dose of baclofen, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of admimstration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, h general, the total daily dose ranges, for the conditions described herein, is from about 5 mg to about 250 mg.
- a daily dose range should be between about 20 mg to about 150 mg.
- a daily dose range should be between about 30 mg to about 100 mg. In certain embodiments, the daily dose range should be about 40, 50, 60, 70, or 80 mg.
- the therapy may be initiated at a lower dose, perhaps about 5 mg to about 15 mg and increased up to about 35 mg or higher depending on the patient's global response, hi general, children are administered a dosage in the range of about 40, 50 or 60 mg per day, often times in divided dosages.
- Bicuculline Bicuculline is a naturally occurring GABA antagonist. Procedures for the preparation of bicuculline are described in Groenewoud, Robinson J. Chem. Soc. 1936, 199 and Haworth et al. Nature 1950, 165, 529. The pharmacological properties are described in Curtis et al. Nature 1970, 226, 1222. In general, the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1O00 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- Bicuculline has the chemical name (6i?)-6-[(5S)-5,6,7,8-tetahydro-6-methyl-l,3-dioxolo[4,5-g]isoquinolin- 5-yl]furo[3,4-e]l,3-benzodioxol-8(6H)-one and the structure is presented below.
- CACA CACA is a GABA receptor agonist that has the chemical name cts-4-aminocrotonic acid.
- CACA can be purchased from Tocris Cookson Inc. in Ellisville, MO. The pharmacological properties are described in J. Ulloor et al. J. NeurophysioL 2004, 91(4), 1822- 31.
- the total daily dose range is from about 1 mg to about 2O00 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of CACA is presented below.
- ⁇ -CCP ⁇ -CCP is an inverse agonist of the GABA receptor.
- ⁇ -CCP can be purchased from Tocris Cookson Inc. in Ellisville, MO. The pharmacological properties are described in P. Pole et al. Epilepsia 1996, 37(10), 1007-14.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of ⁇ -CCP is presented below.
- CGP 35348 is a GABA-receptor antagonist that has the chemical name 3-
- CGP 35348 (aminopropyl)(diethoxymethyl)phosphinic acid.
- CGP 35348 can be purchased from Tocris
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- CGP 35348 The structure of CGP 35348 is presented below.
- CGP 46381 is a GABA-receptor antagonist that has the chemical name (3- aminopropyl) (cyclohexylmethyl)phosphinic acid.
- CGP 46381 can be purchased from KOMA Biotech, Inc. The pharmacological properties are described in Lingenhoehl, Olpe Pharmacol. Comm. 1993, 3, 49.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1O00 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of CGP 46381 is presented below.
- CGP 52432 is a GABA-receptor antagonist that has the chemical name 3-[[(3,4- dichlorophenyl)methyl]amino]propyl]diethoxymethyl)phosphinic acid.
- CGP 52432 can be purchased from KOMA Biotech, Inc. The pharmacological properties are described in Lanza et al. Eur. J. Pharmacol. 1993, 237, 191; Froestl et al. Pharmacol. Rev. Comm. 1996, S, 127;
- the total daily dose range is from about 1 mg to about
- a daily dose range should be between about 5 mg to about 1000 mg.
- a daily dose range should be between about 10 mg to about 250 mg.
- the structure of CGP 52432 is presented below.
- CGP 54626 is a GABA-receptor antagonist that has the chemical name [S-(R*,R*)]-[3-
- CGP 52432 can be purchased from KOMA Biotech, h e. The pharmacological properties are described in Brugger et al. Eur. J. Pharmacol. 1993, 235, 153; Froestl et al. Pharmacol. Rev.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the stracture of CGP 54626 is presented below.
- CGP 55845 is a GABA-receptor antagonist that has the chemical name (2S)-3-[[(lS)-l- (3 ,4-dichlorophenyl)ethyl] amino-2-hydroxypropyl] (phenylmethyl)phosphinic acid.
- CGP 55845 can be purchased from KOMA Biotech, hie. The phannacological properties are described in Davies et al. Neuropharmacology 1993, 32, 1071; Froestl et al. Pharmacol. Rev. Comm. 1996, 8, 127; and Deisz Neuroscience 1999, 93, 1241.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the stracture of CGP 55845 is presented below.
- Clonazepam is an antianxiety agent marketed under the tradename KLONOPIN® .
- Clonazepam has the chemical name 5-(2-chlorophenyl)-l,3-dihydro-7-nitro-2H-l,4- benzodiazepin-2-one and the structure is presented below.
- a prophylactic or therapeutic dose of clonazepam, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 1 mg to about 40 mg.
- a daily dose range should be between about 2 mg to about 30 mg. Most preferably, a daily dose range should be between about 4 mg to about 20 mg. hi certain embodiments, the daily dose range should be about 8, 12, or 16 mg.
- Diazepam is a benzodiazepine used to relieve anxiety, nervousness, and tension associated with anxiety disorders, hi addition, diazepam is used to treat certain seizure disorders and muscle spasms. Procedures for the preparation of diazepam are described in U.S. Patents 3,371,085; 3,109,843; and 3,136,815. The pharmacological properties are described in Hudson, Wolpert 4rc/ ⁇ Int. Pharmacodyn. Ther. 1970, 186, 388; M. Mandelli et al. Clin.
- Diazepam has the chemical name 7-chloro-l,3-dihydro-l-methyl-5-phenyl-2H-l,4- benzodiazepin-2-one and the stracture is presented below.
- a prophylactic or therapeutic dose of diazepam, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 0.5 mg to about 200 mg.
- a daily dose range should be between about 1 mg to about 100 mg.
- a daily dose range should be between about 5 mg to about 40 mg.
- the daily dose range should be about 10, 15, 20, 25, 30 or 35 mg.
- the therapy may be initiated at a lower dose, perhaps about 3 mg to about 4 mg and increased up to about 12 mg or higher depending on the patient's global response.
- Flumazenil Flumazenil is a imidazodiazepine marketed under the tradename ROMAZICON®. Procedures for the preparation of flumazenil are described in U.S. Patent 4,316,839. The pharmacological properties are described in W. Hunkeler et al. Nature 1981, 290, 514; S. E. File et al. Psychopharmacol. 1986, 89, 113; and A. Darragh et al. Lancet 1981, 2, 8.
- Flumazenil has the chemical name 8-fluoro-5,6-dihydro-5-methyl-6-oxo-4H-imidazo[l,5- a][l,4]benzodiazepine-3 -carboxylic acid ethyl ester and the structure is presented below.
- a prophylactic or therapeutic dose of flumazenil, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 0.01 mg to about 4.0 mg.
- a daily dose range should be between about 0.1 mg to about 2.0 mg.
- a daily dose range should be between about 0.2 mg to about 1.0 mg.
- the daily dose range should be about 0.4, 0.6, or 0.8 mg.
- Gabaventin is a GABA-receptor agonist marketed under the tradename NEURONTiN ® Procedures for the preparation of gabapentin are described in U.S. Patent 4,024,175. The pharmacological properties are described in K.O. Vollmer et al. Arzneistoff-Forsch. 1986, 36, 830 and The US Gabapentin Study Group No. 5 Neurology 1993, 43, 2292. Gabapentin has the chemical name l-(aminomethyl)cyclohexaneacetic acid and the structure is presented below.
- a prophylactic or therapeutic dose of gabapentin, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 100 mg to about 3000 mg.
- a daily dose range should be between about 450 mg to about 2400 mg.
- a daily dose range should be between about 900 mg to about 1800 mg.
- the daily dose range should be about 1100, 1300, 1500, or 1700 mg.
- the therapy maybe initiated at a lower dose, perhaps about 500 mg to about 700 mg and increased up to about 1400 mg or higher depending on the patient's global response.
- children ages 3-12 years old are given a smaller dosage.
- a child between the age of 3-12 years old may be given a dose in the range of about 10-15 mg/kg/day up to about 25-35 mg/kg/day.
- 2-Hydroxysaclofen is a GABA-receptor antagonist that has the chemical name (RS)-3- amino-2-(4-chlorophenyl)-2-hydroxypropyl-sulphonic acid.
- 2-Hydroxysaclofen can be purchased from KOMA Biotech, Inc.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of 2-hydroxysaclofen is presented below.
- Isoguvacine is a GABA receptor agonist.
- the pharmacological properties of isoguvacine are described in Chebib, M.; Johnston, G. A. Clin. Exp. Pharamacol. Physiol. 1999, 26, 937-940; X. Leinekugel et al. J. Physiol. 1995, 487, 319-29; and White, W. F.; Snodgrass, S. R. J. Neurochem. 1983, 40(6), 1701-8.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the stracture of isoguvacine is presented below.
- Lamotrigine (LAMICTALX) Lamotrigine is a GABA-receptor agonist marketed under the tradename LAMICTAL ® .
- Lamotrigine has the chemical name 6-(2,3-dichlorophenyl)-l,2,4-triazine-3,5- diamine and the stracture is presented below.
- a prophylactic or therapeutic dose of lamotrigine, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, h general, the total daily dose ranges, for the conditions described herein, is from about 5 mg to about 1000 mg.
- a daily dose range should be between about 25 mg to about 750 mg.
- a daily dose range should be between about 50 mg to about 500 mg. In certain embodiments, the daily dose range should be about 100, 200, 300 or 400 mg.
- the therapy may be initiated at a lower dose, perhaps about 40 mg to about 75 mg and increased up to about 250 mg or higher depending on the patient's global response.
- Lorazepam Lorazepam is an antianxiety agent marketed under the tradename ATIVAN ® . Procedures for the preparation of lorazepam are described in U.S. Patent 3,296,249. The pharmacological properties are described mArzneistoff-Forsch. 1971, 21, 1047-1102 and Ameer, B.; Greenblatt, D. J. Drugs 1981, 21, 161-200. Lorazepam has the chemical name 7- chloro-5-(2-chlorophenyl)-l,3-dihydro-3-hydroxy-2H-l,4-benzodiazepin-2-one and the stracture is presented below.
- a prophylactic or therapeutic dose of lorazepam, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, h general, the total daily dose ranges, for the conditions described herein, is from about 0.1 mg to about 20 mg.
- a daily dose range should be between about 0.5 mg to about 13 mg.
- a daily dose range should be between about 1 mg to about 6 mg.
- the daily dose range should be about 2, 3, 4, or 5 mg.
- the therapy may be initiated at a lower dose, perhaps about 0.6 mg to about 0.8 mg and increased up to about 1.5 mg or higher depending on the patient's global response.
- L-655708 L-655708 is a benzodiazepine that binds selectively to the GABAA receptor.
- L-655708 has the chemical name 11, 12,13, 13a-tetrahydro-7-methoxy-9-oxo-9H-imidazo[l,5- a]pyrrolo[2,l-c][l,4]benzodiazepine-l-carboxylic acid, ethyl ester.
- L-655708 can be purchased from KOMA Biotech, Inc. The pharmacological properties are described in Quirk et al. Neuropharmacology 1996, 35, 1331; Sur et al. Mol. Pharmacol. 1998, 54, 928; and Sur et al. Brain Res. 1999, 522, 265.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- Midazolam is a short-acting derivative of diazepam. Procedures for the preparation of midazolam are described in U.S. Patent 4,280,957. The pharmacological properties are described in Brit. J. Clin. Pharmacol. 1983, 16 (Suppl. 1), 1S-199S; J. W. Dundee et al. Drugs 1984, 28, 519-543; and E. Lahat et al. Brit. Med. J. 2000, 321, 83.
- Midazolam has the chemical name 8-chloro-6-(2-fluorophenyl)-l-methyl-4H-imidazo[l,5-a][l,4]benzodiazepine and the structure is presented below.
- a prophylactic or therapeutic dose of midazolam, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 0.5 mg to about 100 mg.
- a daily dose range should be between about 1 mg to about 40 mg.
- a daily dose range should be between about 4 mg to about 20 mg.
- the daily dose range should be about 8, 12, or 16 mg.
- Muscimol is a GABA-receptor agonist that has the chemical name 5-(aminomethyl)- 3(2H)-isoxazolone. Procedures for the preparation of muscimol are described in Nakamura Chem. Pharm. Bull. 1971, 19, 46 and McCarry, B. E.; Savard, M. Tetrahedron Letters 1981, 22, 5153. The pharmacological properties are described in Theobald et al. Arzneistoff- Forsch. 1968, 18, 311 and F. V. DeFeudis Neurochem. Res.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of muscimol is presented below.
- Phaclofen is a GABA-receptor antagonist that has the chemical name 3-amino-2-(4- chlorophenyl)propylphosphonic acid. Phaclofen can be purchased from KOMA Biotech, Inc.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the stracture of phaclofen is presented below.
- Phenvtoin (DILANTIN ® ) Phenytoin is a GABA-receptor agonist marketed under the tradename DILANTIN ® . Procedures for the preparation of phenytoin are described in U.S. Patent 2,409,754. The pharmacological properties are described in Gillis et al. J. Pharmacol. Exp. Ther. 1971, 179, 599 and J. Philip et al. Anal. Profiles Drug Subs. 1984, 13, 417-445. In certain instances, the sodium salt of phenytoin is preferred. Phenytoin has the chemical name 5,5-diphenyl-2,4- imidazolidinedione and the stracture is presented below.
- a prophylactic or therapeutic dose of phenytoin, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 5 mg to about 600 mg.
- a daily dose range should be between about 15 mg to about 450 mg.
- a daily dose range should be between about 25 mg to about 300 mg.
- the daily dose range should be about 50, 100, 150, 200, or 250 mg.
- the therapy may be initiated at a lower dose, perhaps about 10 mg to about 20 mg and increased up to about 75 mg or higher depending on the patient's global response.
- Pregabalin is an isobutyl analog of GABA developed by Pfizer in collaboration with researchers at Northwestern University. Pregabalin has a more linear relationship between drag plasma levels and the dosage of the drug compared to gabapentin. Procedures for the preparation of pregabalin are described in M. J. Burk et al. J. Org. Chem. 2003, 68, 5731-5734. The pharmacological properties are described in Bayes, M.; Rabasseda, X.; Prous, J.R. Methods Find Exp. Clin. Pharmacol.
- Pregabalin has the chemical name (S)-(+)-3-aminomethyl-5-methylhexanoic acid and the stracture is presented below.
- a prophylactic or therapeutic dose of pregabalin, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 5 mg to about 1200 mg.
- a daily dose range should be between about 30 mg to about 800 mg.
- a daily dose range should be between about 75 mg to about 600 mg.
- the daily dose range should be about 100, 150, 250, 400, or 500 mg.
- the therapy may be initiated at a lower dose, perhaps about 50 mg to about 65 mg and increased up to about 125 mg or higher depending on the patient's global response.
- Progabide (GABRENE ® ) Progabide is a GABA receptor antagonist marketed under the tradename GABRENE ⁇
- a prophylactic or therapeutic dose of progabide, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient, hi general, the total daily dose ranges, for the conditions described herein, is from about 5 mg/kg/day to about 75 mg/kg/day.
- a daily dose range should be between about 15 mg/kg/day to about 55 mg/kg/day.
- a daily dose range should be between about 25 mg/kg/day to about 45 mg/kg/day.
- the daily dose range should be about about 30, 35, or 40 mg/kg/day.
- the therapy may be initiated at a lower dose, perhaps about 10 mg/kg/day to about 15 mg/kg/day and increased up to about 30 mg/kg/day or higher depending on the patient's global response.
- Riluzole Riluzole is a benzothiazole derivative marketed by Rhone Poulenc Rorer. Procedures for the preparation of riluzole are described in U.S. Patent 4,370,338 and EP 50,551. The pharmacological properties are described in j. Mizoule et al. Neuropharmacology 1985, 24, 161 amd M.W. Debono et al. Eur. J. Pharmacol. 1993, 235, 283. Riluzole has the chemical name 6-(trifluoromethoxy)benzothiazolamine and the stracture is presented below.
- a prophylactic or therapeutic dose of riluzole, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 5 mg to about 250 mg.
- a daily dose range should be between about 50 mg to about 175 mg.
- a daily dose range should be between about 80 mg to about 120 mg.
- the daily dose range should be about 90, 100, or 110 mg.
- the therapy may be initiated at a lower dose, perhaps about 60 mg to about 70 mg and increased up to about 100 mg or higher depending on the patient's global response.
- Saclofen Saclofen is a GABA-receptor antagonist that has the chemical name (i?S)-3-amino-2-(4- chlorophenyl)propylsulphonic acid. Saclofen can be purchased from KOMA Biotech, Inc. The pharmacological properties are described in Bowery TiPS. 1989, 10, 401; Kerr et al. Neurosci. Lett. 1989, 107, 239; and Jane et al. in GABA B Receptors in Mammalian Function. Eds.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of saclofen is presented below.
- SCH 50911 is a GABA-receptor antagonist that has the chemical name (2S)-5,5- dimethyl-2-mo ⁇ holineacetic acid.
- SCH 50911 can be purchased from KOMA Biotech, Inc. The pharmacological properties are described in Bolser et al. J. Pharmacol. Exp. Ther. 1996, 274, 1393; Hosford et al. J. Pharmacol Exp. Ther. 1996, 274, 1399; and Ong et al. Eur. J. Pharmacol. 1998, 362, 35.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the stracture of SCH 50911 is presented below.
- SKF 97541 is a GABA-receptor agonist with the chemical name 3- aminopropyl(methyl)phosphinic acid.
- SKF 97541 is a white solid that is readily soluble in safer and dilute aqueous base.
- SKF 97541 can be purchased from A.G. Scientific, Inc. located in
- the hydrochloride salt is prefened.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the structure of SKF 97541 is presented below.
- SR 95531 is a GABA-receptor antagonist. SR 95531 can be purchased from Tocris
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- Tiagabine is a GABA uptake inhibitor marketed under the tradename GABITIRIL ® .
- Procedures for the preparation of tiagabine are described in U.S. Patent 5,010,090 and K. E. Andersen et al. J. Med. Chem. 1993, 36, 1716.
- the pharmacological properties are described in C. L. Faingold et al. Exp. Neurology 1994, 126, 225 and W. J. GiardinaJ Epilepsy 1994, 7, 161-166.
- Tiagabine has the chemical name (i?)-l-[4,4-bis(3-methyl-2-thienyl)-3-butenyl]-3- piperidinecarboxylic acid and the stracture is presented below.
- a prophylactic or therapeutic dose of tiagabine, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 1 mg to about 100 mg.
- a daily dose range should be between about 15 mg to about 50 mg.
- a daily dose range should be between about 30 mg to about 35 mg.
- the daily dose range should be about 32 or 34 mg.
- the therapy may be initiated at a lower dose, perhaps about 5 mg to about 10 mg and increased up to about 20 mg or higher depending on the patient's global response.
- TPMPA TPMPA is a GABA-receptor antagonist.
- TPMPA can be purchased from Tocris Cookson h e. in Ellisville, MO. The pharmacological properties of TPMPA are described in K. Schlicker et al. Brain Res. Bull. 2004, 63(2), 91-7.
- the total daily dose range is from about 1 mg to about 2000 mg.
- a daily dose range should be between about 5 mg to about 1000 mg. More preferably, a daily dose range should be between about 10 mg to about 250 mg.
- the stracture of isoguvacine is presented below.
- Topiramate (TOPAMAX ® ) Topiramate is a fructopyranose derivative marketed under the tradename TOPAMAX ® . Procedures for the preparation of topiramate are described in U.S. Patent 4,513,006. The pharmacological properties are described in M. Bialer Clin. Pharmacokinet. 1993, 24, 441 and B. E. Maryanoff et al J. Med. Chem. 1987, 30, 880. Topiramate has the chemical name
- a prophylactic or therapeutic dose of topiramate, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 5 mg to about 400 mg.
- a daily dose range should be between about 100 mg to about 300 mg.
- a daily dose range should be between about 170 mg to about 230 mg.
- the daily dose range should be about 180, 190, 200, 210, or 220 mg.
- Valproic Acid has the chemical name 2-propylpentanoic acid and is used to treat migraine headaches and prevent seizures in people suffering from epilepsy. Procedures for the preparation of valproic acid are described in Weimann, Thuan t ⁇ //. Soc. Chim. France 1958, 199. The pharmacological properties are described in Rimmer, E. M.; Richens, A. Pharmacother. 1985, 5, 171-184 and Z. L. Chang in Analytical Profiles of Drug Substances vol. 8, K. Florey, Ed. (Academic Press, New York, 1979) pp 529-556. The structure of valproic acid is presented below.
- a prophylactic or therapeutic dose of valproic acid, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 5 mg to about 900 mg.
- a daily dose range should be between about 25 mg to about 700 mg.
- a daily dose range should be between about 50 mg to about 500 mg.
- the daily dose range should be about 100, 200, 300 or 400 mg.
- Vigabatrin has the chemical name 4-amino-5-hexenoic acid and is used to prevent seizures in people suffering from epilepsy. Procedures for the preparation of vigabatrin are described in U.S. Patent 3,960,927. The pharmacological properties are described in K. D. Haegele et al. Clin. Pharmacol. Ther. 1986, 40, 581 and Grant, S. M.; Heel, R. C. Drugs 1991, 41, 889-926. The stracture of vigabatrin is presented below.
- a prophylactic or therapeutic dose of vigabatrin, or one of its salts, in the acute or chronic management of disease will vary with the severity of the condition to be treated and the route of administration.
- the dose, and perhaps the dose frequency, will also vary according to the age, body weight, and response of the individual patient.
- the total daily dose ranges, for the conditions described herein is from about 100 mg to about 5000 mg.
- a daily dose range should be between about 500 mg to about 4000 mg.
- a daily dose range should be between about 1000 mg to about 3000 mg.
- the daily dose range should be about 1200, 1500, 2000, or 2500 mg.
- the therapy may be initiated at a lower dose, perhaps about 700 mg to about 900 mg and increased up to about 1300 mg or higher depending on the patient's global response.
- Additional GABA receptor modulating compounds amenable to the present invention include the GABA receptor agonists described in U.S. Patent Application 20030162754 and WO 02/06786, which are hereby inco ⁇ orated by reference.
- compounds amenable to the present invention include 4-amino-3-phenylbutanoic acid, 4-amino-3- hydroxybutanoic acid, 4-amino-3-(4-chlorophenyl)-3-hydroxyphenylbutanoic acid, 4-amino-3- (thien-2-yl)butanoic acid, 4-amino-3-(5-chlorothien-2-yl)butanoic acid, 4-amino-3-(5- bromothien-2-yl)butanoic acid, 4-amino-3-(5-methylthien-2-yl)butanoic acid, 4-amino-3-(2- imidazolyl)butanoic acid, 4-guanidino-3-(4-chlorophenyl) butanoic acid, 3-amino-2-(4- chlorophenyl)- 1-nitropropane, (3-aminopropyl)phosphonous acid, (4-aminobut-2- yl)phosphonous acid
- GABA receptor modulating compounds amenable to the present invention include the GABA receptors agonsits described in U.S. Patent 6,399,608; which is hereby inco ⁇ orated by reference.
- compounds amenable to the present invention include 3,7-diphenyl-6-(2-pyridyl)methyloxy- l,2,4-triazolo[4,3-b]pyridazine; 7,8-dimethyl-3-phenyl- 6-(2-pyridyl)methyloxy- l,2,4-triazolo[4,3-b]pyridazine; 7-methyl-3-phenyl-6-(2- pyridyl)methyloxy-l ,2,4-triazolo[4,3-b]pyridazine; b 7-ethyl-3-phenyl-6-(2- pyridyl)methyloxy-l,2,4-triazolo[4,3-b]pyridazine; 8-methyl-3,7-diphen
- Additional GABA modulating agents for use in the present invention are 3-aminopropyl phosphinic acid and (7S,2i?)-(+)-2-(aminomethyl)-cyclopropane-l-carboxylate.
- the stracture of 3-amino-propyl phosphinic acid is presented below.
- Combination Therapy One aspect of the present invention relates to combination therapy.
- This type of therapy is advantageous because the co-administration of active ingredients achieves a therapeutic effect that is greater than the therapeutic effect achieved by administration of only a single therapeutic agent, h one embodiment, the co-administration of two or more therapeutic agents achieves a synergistic effect, i.e., a therapeutic affect that is greater than the sum of the therapeutic effects of the individual components of the combination, h another embodiment, the co-administration of two or more therapeutic agents achieves an augmentation effect.
- the active ingredients that comprise a combination therapy may be administered together via a single dosage form or by separate administration of each active agent.
- the first and second therapeutic agents are administered in a single dosage fonn.
- the agents may be formulated into a single tablet, pill, capsule, or solution for parenteral administration and the like.
- the first therapeutic agent and the second therapeutic agents may be administered as separate compositions, e.g., as separate tablets or solutions.
- the first active agent may be administered at the same time as the second active agent or the first active agent may be administered intermittently with the second active agent.
- the length of time between administration of the first and second therapeutic agent maybe adjusted to achieve the desired therapeutic effect, hi certain instances, the second therapeutic agent may be administered only a few minutes (e.g., 1, 2, 5, 10, 30, or 60 min) after administration of the first therapeutic agent.
- the second therapeutic agent maybe administered several hours (e.g., 2, 4, 6, 10, 12, 24, or 36 hr) after admimstration of the first therapeutic agent.
- the second therapeutic agent may be administered at 2 hours and then again at 10 hours following administration of the first therapeutic agent.
- the dosage of the active agents will generally be dependent upon a number of factors including pharmacodynamic characteristics of each agent of the combination, mode and route of admimstration of active agent(s), the health of the patient being treated, the extent of treatment desired, the nature and kind of concurrent therapy, if any, and the frequency of treatment and the nature of the effect desired.
- dosage ranges of the active agents often range from about 0.001 to about 250 mg/kg body weight per day. For example, for a nonnal adult having a body weight of about 70 kg, a dosage in the range of from about 0.1 to about 25 mg/kg body weight is typically prefened.
- some variability in this general dosage range may be required depending upon the age and weight of the subject being treated, the intended route of administration, the particular agent being administered and the like.
- the potency of each agent and the interactive effects achieved using them together must be considered.
- the determination of dosage ranges and optimal dosages for a particular mammal is also well within the ability of one of ordinary skill in the art having the benefit of the instant disclosure.
- the ratio of the first active agent to second active agent is 30:1, 20:1, 15:1, 10:1, 9:1, 8:1, 7:1, 6:1, or 5:1.
- the ratio of the first active agent to the second active agent is 4:1, 3:1, 2:1, 1:1, 1:2, 1:3, or 1:4.
- it may be advantageous for the pharmaceutical combination to have a relatively large amount of the second component compared to the first component h certain instances, the ratio of the second active agent to the first active agent is 30:1, 20:1, 15:1, 10:1, 9:1, 8:1, 7:1, 6:1, or 5:1.
- a composition comprising any of the above-identified combinations of first therapeutic agent and second therapeutic agent may be administered in divided doses 1, 2, 3, 4, 5, 6, or more times per day or in a form that will provide a rate of release effective to attain the desired results.
- the dosage form contains both the first and second active agents.
- the dosage form only has to be administered one time per day and the dosage form contains both the first and second active agents.
- a fonnulation intended for oral administration to humans may contain from 0. 1 mg to 5 g of the first therapeutic agent and 0.1 mg to 5 g of the second therapeutic agent, both of which are compounded with an appropriate and convenient amount of carrier material varying from about 5 to about 95 percent of the total composition.
- Unit dosages will generally contain between from about 0.5 mg to about 1500 mg of the first therapeutic agent and 0.5 mg to about 1500 mg of the second therapeutic agent.
- the dosage comprises 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg, 10 mg, 25 mg, 50 mg, 100 mg, 200 mg, 30O mg, 400 mg, 500 mg, 600 mg, 800 mg, or 1000 mg, etc., up to 1500 mg of the first therapeutic agent.
- the dosage comprises 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg, 10 mg, 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg, 500 mg, 600 mg, 800 mg, or 1000 mg, etc., up to 1500 mg of the second therapeutic agent.
- the optimal ratios of the first and second therapeutic agent can be determined by standard assays known in the art.
- the phenyl-p-benzoquinone test may be used to establish analgesic effectiveness.
- the phenyl-p-benzoquinone induced writhing test in mice (H. Blumberg et al., 1965, Proc. Soc. Exp. Med. 118:763-766) and known modifications thereof is a standard procedure which may be used for detecting and comparing the analgesic activity of different classes of analgesic drugs with a good correlation with human analgesic activity.
- Data for the mouse, as presented in an isobologram can be translated to other species where the orally effective analgesic dose of the individual compounds are known or can be estimated.
- the method consists of reading the percent ED50 dose for each dose ratio on the best fit regression analysis curve from the mouse isobologram, multiplying each component by its effective species dose, and then fonning the ratio of the amount of COX-2 inhibitor and opioid analgesic.
- This basic conelation for analgesic properties enables estimation of the range of human effectiveness (E. W. Pelikan, 1959, The Pharmacologist 1:73).
- application of an equieffective dose substitution model and a curvilinear regression analysis utilizing all the data for the individual compounds and various dose ratios for the combinations can be used to establish the existence of unexpectedly enhanced analgesic activity of combinations of active agents, i.e., the resulting activity is greater than the activity expected from the sum of the activities of the individual components.
- the toxicity and therapeutic efficacy of such compounds can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., for determining the LD 50 (the dose lethal to 50% of the population) and the ED 50 (the dose therapeutically effective in 50% of the population).
- the dose ratio between toxic and therapeutic effects is the therapeutic index and it can be expressed as the ratio LD S Q/EDSO- Compounds which exhibit large therapeutic indices are prefened.
- the data obtained from these cell culture assays and animal studies can be used in formulating a range of dosage for use in humans.
- the dosage of such compounds lies preferably within a range of circulating concentrations that include the ED 50 with little or no toxicity. The dosage may vary within this range depending upon the dosage form employed and the route of administration utilized.
- the therapeutically effective dose can be estimated initially from cell culture assays.
- a dose may be formulated in animal models to achieve a circulating plasma concentration range that includes the IC 50 (i.e., the concentration of the test compound which achieves a half-maximal inhibition of RT production from infected cells compared to untreated control as determined in cell culture. Such information can be used to more accurately determine useful doses in humans.
- Levels in plasma may be measured, for example, by high performance liquid chromatography (HPLC). Synergism and Augmentation
- HPLC high performance liquid chromatography
- a synergistic effect permits the effective treatment of a disease using lower amounts (doses) of either individual therapy.
- the lower doses result in lower toxicity without reduced efficacy.
- a synergistic effect can result in improved efficacy, e.g., improved antiviral activity.
- synergy may result in an improved avoidance or reduction of disease as compared to any single therapy.
- Combination therapy can allow for the use of lower doses of the first therapeutic or the second therapeutic agent (refened to as "apparent one-way synergy” herein), or lower doses F both therapeutic agents (refened to as "two-way synergy” herein) than would normally be required when either drag is used alone.
- the synergism exhibited between the second therapeutic agent and the first therapeutic agent is such that the dosage of the first therapeutic agent would be sub-therapeutic if administered without the dosage of the second therapeutic agent.
- the synergism exhibited between the second therapeutic agent and the first therapeutic agent is such that the dosage of the second therapeutic agent would be sub- therapeutic if administered without the dosage of the first therapeutic agent.
- augmentation or “augment” refer to combination where one of the compounds increases or enhances therapeutic effects of another compound or compounds administered to a patient, hi some instances, augmentation can result in improving the efficacy, tolerability, or safety, or any combination thereof, of a particular therapy.
- the present invention relates to a phannaceutical composition comprising a therapeutically effective dose of a first therapeutic agent together with a dose of a second therapeutic agent effective to augment the therapeutic effect of the first therapeutic agent.
- the present invention relates to methods of augmenting the therapeutic effect in a patient of a first therapeutic agent by administering the second therapeutic agent to the patient.
- the present invention relates to a pharmaceutical composition comprising an therapeutically effective dose of a second therapeutic agent together with a dose of a first therapeutic agent effective to augment the therapeutic effect of the second therapeutic agent.
- the present invention relates to methods of augmenting the therapeutic effect in a patient of a second therapeutic agent by administering the first therapeutic agent to the patient.
- the invention is directed in part to synergistic combinations of the first therapeutic agent in an amount sufficient to render a therapeutic effect together with a second therapeutic agent.
- a therapeutic effect is attained which is at least about 2 (or at least about 4, 6, 8, or 10) times greater than that obtained with the dose of the first therapeutic agent alone.
- the synergistic combination provides a therapeutic effect which is up to about 20, 30 or 40 times greater than that obtained with the dose of first therapeutic agent alone.
- the synergistic combinations display what is refened to herein as an "apparent one-way synergy", meaning that the dose of second therapeutic agent synergistically potentiates the effect of the first therapeutic agent, but the dose of first therapeutic agent does not appear to significantly potentiate the effect of the second therapeutic agent.
- the combination of active agents exhibit two-way synergism, meaning that the second therapeutic agent potentiates the effect of the first therapeutic agent, and the first therapeutic agent potentiates the effect of the second therapeutic agent.
- other embodiments of the invention relate to combinations of a second therapeutic agent and a first therapeutic agent where the dose of each drag is reduced due to the synergism between the drags, and the therapeutic effect derived from the combination of drags in reduced doses is enhanced.
- the two-way synergism is not always readily apparent in actual dosages due to the potency ratio of the first therapeutic agent to the second therapeutic agent.
- two- way synergism can be difficult to detect when one therapeutic agent displays much greater therapeutic potency relative to the other therapeutic agent.
- the synergistic effects of combination therapy may be evaluated by biological activity assays.
- the therapeutic agents are be mixed at molar ratios designed to give approximately equipotent therapeutic effects based on the EC 90 values.
- This program evaluates drug interactions by use of the widely accepted method of Chou and Talalay combined with a statistically evaluation using the Monte Carlo statistical package.
- the data are displayed in several different formats including median-effect and dose-effects plots, isobolograms, and combination index [CI] plots with standard deviations.
- CI combination index
- compositions & Methods of the Invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a serotonin reuptake inhibitor.
- Another aspect of the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a serotonin reuptake inhibitor, wherein said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said present invention relates to the aforementioned pharmaceutical composition, wherein said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a serotonin reuptake inhibitor, wherein said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- a pharmaceutically acceptable carrier consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo
- the present invention relates to the aforementioned pharmaceutical composition, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said present invention relates to the aforementioned pharmaceutical composition, wherein said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable canier.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, ( escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- said insomnia is transient insomnia.
- the present invention relates to the aforementioned method, wherein said insomnia is short-term insomnia.
- the present invention relates to the aforementioned method, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable earner.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said depression is a major depressive disorder.
- Another aspect of the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a norepinephrine reuptake inhibitor.
- Another aspect of the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned phannaceutical composition, wherein said norepinephrine reuptake inhibitor is (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said present invention relates to the aforementioned pharmaceutical composition, wherein said norepinephrine reuptake inhibitor is (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybu ⁇ ropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a ' pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said insomnia is transient insomnia. In certain embodiments, the present invention relates to the aforementioned method, wherein said insomnia is short-term insomnia. In certain embodiments, the present invention relates to the aforementioned method, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said depression is a major depressive disorder.
- Another aspect of the present invention relates to a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a dopamine reuptake inhibitor.
- Another aspect of the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a dopamine reuptake inhibitor
- said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ - (4-tolyl)-xropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is bupropion, or GBR- 12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)-desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a phannaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a dopamine reuptake inhibitor, said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ - propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable canier.
- a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a dopamine reuptake inhibitor, said dopamine reuptake inhibitor is amineptine
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is bupropion, or GBR- 12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)-desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- a dopamine reuptake inhibitor wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymorph, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them. h certain embodiments, the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- a dopamine reuptake inhibitor wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935,
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (-+ ⁇ )- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said insomnia is transient insomnia. In certain embodiments, the present invention relates to the aforementioned method, wherein said insomnia is short-tenn insomnia. ' In certain embodiments, the present invention relates to the aforementioned method, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- a dopamine reuptake inhibitor wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935,
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said depression is a major depressive disorder.
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a 5-HT 2A modulator.
- the present invention relates to the aforementioned pharmaceutical composition, wherein the 5-HT 2A modulator is a 5-HT A antagonist.
- the present invention relates to the aforementioned pharmaceutical composition, wherein the 5-HT 2A modulator is a 5-HT A inverse agonist.
- Another aspect of the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a 5-HT 2A modulator, wherein said 5 HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, or azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said 5-HT A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co crystal of any one of them.
- said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said 5-HT 2A modulator, wherein said 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, or azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a 5-HT 2A modulator; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned pharmaceutical composition, wherein the 5-HT 2A modulator is a 5-HT A antagonist. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein the 5-HT A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a 5-HT 2A modulator, wherein said 5 HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, or azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- a pharmaceutical composition consisting essentially of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a 5-HT 2A modulator, where
- the present invention relates to the aforementioned pharmaceutical composition, wherein said 5-HT A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said 5-HT A modulator, wherein said 5 HT2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, or azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT A modulator.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned method, wherein the 5-HT A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clathrate, polyrno ⁇ h, or co-crystal of any one of them.
- the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clathrate, polyrno ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2A modulator; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned method, wherein the 5-HT A modulator is a 5-HT A inverse agonist.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- a 5-HT 2A modulator wherein said 5-HT 2A modulator is MDL 100907,
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator.
- the present invention relates to the aforementioned method, wherein the 5-HT A modulator is a 5-HT A antagonist.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2 A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amoxmt of a 5-HT 2 ⁇ modulator; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT A antagonist.
- the present invention relates to the aforementioned method, wherein the 5-HT 2 A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable canier.
- a 5-HT 2A modulator wherein said 5-HT 2A modulator is MDL 100907, SR 463
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said insomnia is transient insomnia.
- the present invention relates to the aforementioned method, wherein said insomnia is short-term insomnia.
- the present invention relates to the aforementioned method, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5- HT 2A modulator; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT A antagonist.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5- HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the 5-HT A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein said depression is a major depressive disorder.
- Another aspect of the present invention relates to a method for augmentation of antidepressant therapy in a patient comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method for eliciting a dose sparing effect in a patient undergoing treatment with an antidepressant, comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof.
- Another aspect of the present invention relates to a method for reducing depression relapse in a patient who received antidepressant treatment, comprising administering to the patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein the eszopiclone is administered chronically or long-term.
- Another aspect of the present invention relates to a method for improving the tolerability of antidepressant therapy in a patient suffering from depression, comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein the antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the antidepressant is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S) hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the antidepressant is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S) hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the antidepressant is bupropion, venlafaxine, or desmethylvenlafaxine, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherien the desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)-desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned method, wherein the antidepressant is a dopamine reuptake inhibitor or an atypical antidepressant.
- the antidepressant is a dopamine reuptake inhibitor or an atypical antidepressant.
- a pharmaceutical composition comprising a sedative agent and an antidepressant.
- the antidepressant is a serotonin reuptake inhibitor, including without limitation selective serotonin reuptake inhibitors, a norepinephrine reuptake inhibitor, including without limitation a selective norepinephrine reuptake inhibitor, a dopamine reuptake inhibitor, or an atypical antidepressant.
- the antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Ki is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 75 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Ki is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mihiacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clatli
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a serotonin reuptake inliibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof and fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a norepinephrine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Ki is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 75 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a norepinephrine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is racemic zopiclone, eszopiclone
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a norepinephrine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof
- said norepinephrine reuptake inhibitor is desipramine,
- the present invention relates to the aforementioned pharmaceutical composition, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a norepinephrine reuptake inhibitor; wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a 5-HT 2 receptor modulator, i certain embodiments, the 5- HT 2 receptor modulator is a 5-HT 2A receptor antagonist or a 5-HT 2A inverse agonist.
- the pharmaceutical composition comprises a sedative agent and a 5-HT 2 receptor modulator, wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said said 5-HT 2 receptor modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay
- said 5-HT 2 receptor modulator is MDL 100907, SR 46349B, YM 99
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned phannaceutical composition, wherein said Kj is less than about 75 nM. hi certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a 5-HT 2A modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5- HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- said sedative agent is racemic zopiclone, eszopiclone, indiplo
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a 5-HT A modulator; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof
- said 5-HT 2A modulator is MDL 100907, SR 46349
- the present invention relates to the aforementioned phannaceutical composition, wherein said 5-HT 2 A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising eszopiclone and a 5-HT 2 A modulator; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a 5-HT 2A inverse agonist.
- the 5-HT 2A inverse agonist is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them
- a pharmaceutical composition comprising a sedative agent and a dopamine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 75 nM. i certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a ' pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon,
- Another aspect of the present invention relates to a pharmaceutical composition, comprising a sedative agent and a dopamine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof
- said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -prop
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is bupropion, GBR- 12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- a pharmaceutical composition comprising eszopiclone and bupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Ki is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 75 nM. hi certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Ki is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of
- the present invention relates to the aforementioned pharmaceutical composition, wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- a phannaceutical composition consisting essentially of a sedative agent, a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal therof, and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay
- the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 75 nM. hi certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said K; is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a norepinephrine reuptake inhibitor, and at least one phannaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is race
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepinephrine reuptake inliibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof
- the present invention relates to the aforementioned pharmaceutical composition, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, a norepinephrine reuptake inhibitor, and at least one phannaceutically acceptable carrier; wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a 5-HT 2A modulator, and at least one phannaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Ki is less than about 150 nM.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 75 nM.
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a 5-HT 2A modulator, and at least one phannaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is racemic z
- a phannaceutical composition consisting essentially of a sedative agent, a 5-HT 2A modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof
- the present invention relates to the aforementioned pharmaceutical composition, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, a 5-HT 2 A modulator, and at least one pharmaceutically acceptable carrier; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay
- said dopamine reuptake inhibitor is amineptine, bupropion, GBR
- the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 150 nM. In certain embodiments, the present invention relates to the aforementioned phannaceutical composition, wherein said Kj is less than about 75 nM. hi certain embodiments, the present invention relates to the aforementioned pharmaceutical composition, wherein said Kj is less than about 30 nM.
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is racemic zopiclone, eszopiclone, indiplon
- Another aspect of the present invention relates to a pharmaceutical composition, consisting essentially of a sedative agent, a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ - propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof
- said dopamine reuptake inhibitor is amineptine, bupropion,
- the present invention relates to the aforementioned pharmaceutical composition, wherein said dopamine reuptake inhibitor is bupropion, GBR- 12935, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- a pharmaceutical composition consisting essentially of eszopiclone and bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them, and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative and a therapeutically effective amount of an antidepressant; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said antidepressant is a serotonin reuptake inhibitor, norepinephrine reuptake inhibitor, 5HT 2A modulator, or dopamine reuptake inhibitor.
- the present invention relates to the aforementioned method, wherein said sedative is racemic zopiclone, (S)-zopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, or hydrate of any one of them; and said antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, MDL 100907, SR 46349B, YM 992, fananserin, o
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA- receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mihiacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amoxmt of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inl ibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericl
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amoxmt of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnonnahty, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA- receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate,
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepineplirine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt,
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal; and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said norepineplirine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2A modulator; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2A modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2 A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compomids C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clatl
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnonnahty, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2A modulator; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compomids A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopicl
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone and a therapeutically effective amount of a 5-HT 2A modulator; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less 'than about 300 nM in a GABA- receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ - propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clatlirate
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnonnahty, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of bupropion or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one phannaceutically acceptable canier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay;
- said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amoxmt of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alap
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepineplirine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amoxmt of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)- hydroxybupropion, or a pharmaceutically
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepinephrine reuptake inliibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a norepinephrine reuptake inhibitor; and at least one phannaceutically acceptable carrier; wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5-HT 2A modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5-HT 2A modulator, and at least one phannaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compomids C, azacyclic compounds D, or a pharmaceutically acceptable salt
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5-HT 2A modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopic
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; a therapeutically effective amoxmt of a 5-HT 2A modulator; and at least one pharmaceutically acceptable carrier; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnomiality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4- tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate
- Another aspect of the present invention relates to a method of treating a patient suffering from a sleep abnormality, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of bupropion or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and at least one phannaceutically acceptable carrier.
- the present invention relates to the aforementioned methods, wherein said sleep disturbance is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates generally to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative and a therapeutically effective amount of an antidepressant; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said antidepressant is a serotonin reuptake inhibitor, norepinephrine reuptake inhibitor, 5HT 2 A modulator, or dopamine reuptake inhibitor.
- the present invention relates to the aforementioned method, wherein said sedative is racemic zopiclone, (S)-zopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, or hydrate of any one of them; and said antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, MDL 100907, SR 46349B, YM 992, fananserin
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amoxmt of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising t the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inliibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, poly
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amoxmt of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal; and a therapeutically effective amoxmt of a norepinephrine reuptake inhibitor; wherein said norepineplirine reuptake inliibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2A modulator; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2A modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2 A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amoxmt of a 5-HT 2A modulator; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said 5-HT 2A modulator is MDL 1009O7, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compomids D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone and a therapeutically effective amount of a 5- HT 2A modulator; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amoxmt of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4- tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amoxmt of bupropion or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay
- said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, i
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepineplirine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate,
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one phannaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepinephrine reuptake inliibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)- hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- said sedative agent
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a norepinephrine reuptake inhibitor; and at least one phannaceutically acceptable canier; wherein said norepineplirine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-admimstering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2 A modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2A modulator, and at least one pharmaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate,
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2A modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal of any one of them; a therapeutically effective amount of a 5-HT 2 A modulator; and at least one pharmaceutically acceptable carrier; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nTVl in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clath
- Another aspect of the present invention relates to a method of treating a patient suffering from insomnia, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of bupropion or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and at least one pharmaceutically acceptable carrier.
- the present invention relates to the aforementioned methods, wherein said insomnia is transient insomnia.
- the present invention relates to the aforementioned methods, wherein said insomnia is short-term insomnia.
- the present invention relates to the aforementioned methods, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates generally to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative and a therapeutically effective amount of an antidepressant; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said antidepressant is a serotonin reuptake inhibitor, norepinephrine reuptake inhibitor, 5HT 2 A modulator, or dopamine reuptake inhibitor.
- the present invention relates to the aforementioned method, wherein said sedative is racemic zopiclone, (S)-zopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, or hydrate of any one of them; and said antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, MDL 100907, SR 46349B, YM 992, fananserin, o
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine,
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- Another aspect of the present invention relates to a method of heating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, pofyr
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solv
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal; and a therapeutically effective amount of a norepineplirine reuptake inhibitor; wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2A modulator; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT A modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2 A modulator; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and said 5-HT 2 A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone and a therapeutically effective amount of a 5- HT 2A modulator; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inliibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ - propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of bupropion or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable canier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay;
- said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, i
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amoxmt of a serotonin reuptake inhibitor, and at least one phannaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amoxmt of a serotonin reuptake inhibitor, and at least one phannaceutically acceptable canier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and said serotonin reuptake inhibitor is fluoxetine or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-admimstering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clatlirate, polymorph, or co-crystal thereof; a therapeutically effective amount of fluoxetine hydrochloride or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co- crystal of any one of them.
- said sedative agent is eszopic
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier; wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, (S,S)- hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co- crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5-HT 2A modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compoimds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compomids D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5-HT 2A modulator, and at least one phannaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate,
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5-HT 2A modulator, and at least one phannaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof; and said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; a therapeutically effective amount of a 5-HT 2A modulator; and at least one phannaceutically acceptable carrier; wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said sedative agent is eszopiclone or a pharmaceutically acceptable salt, solvate, clathrate, poly
- Another aspect of the present invention relates to a method of treating a patient suffering from depression, comprising the step of co-administering to a patient in need thereof a therapeutically effective amount of eszopiclone or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; and a therapeutically effective amount of bupropion or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and at least one pharmaceutically acceptable carrier.
- Another aspect of the present invention relates to a method of augmentation of antidepressant therapy in a patient, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay.
- Another aspect of the present invention relates to a method of augmentation of antidepressant therapy in a patient, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- a sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method for augmentation of antidepressant therapy in a patient comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective ampunt of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method for eliciting a dose sparing effect in a patient undergoing treatment with an antidepressant, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay.
- Another aspect of the present invention relates to a method for eliciting a dose sparing effect in a patient undergoing treatment with an antidepressant, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method for eliciting a dose sparing effect in a patient undergoing treatment with an antidepressant, comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof.
- Another aspect of the present invention relates to a method for reducing depression relapse in a patient who received antidepressant treatment, comprising the step of administering to a patient in need thereof, receiving antidepressant treatment, a therapeutically effective amount of a sedative agent; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay.
- Another aspect of the present invention relates to a method for reducing depression relapse in a patient who received antidepressant treatment, comprising the step of administering to a patient in need thereof, receiving antidepressant treatment, a therapeutically effective amount of a sedative agent; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co- crystal of any one of them.
- Another aspect of the present invention relates to a method for reducing depression relapse in a patient who received antidepressant treatment, comprising administering to the patient in need thereof receiving antidepressant treatment, a therapeutically effective amoxmt of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned method, wherein the eszopiclone is administered chronically or long-term.
- Another aspect of the present invention relates to a method for improving the efficacy of antidepressant therapy in a patient suffering from depression, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay.
- Another aspect of the present invention relates to a method for improving the efficacy of antidepressant therapy in a patient suffering from depression, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- a sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method for improving the tolerability of antidepressant therapy in a patient suffering from depression, comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amoxmt of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to a method for improving the tolerability of antidepressant therapy in a patient suffering from depression, comprising the step of administering to a patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of a sedative agent; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to a method for improving the tolerability of antidepressant therapy in a patient suffering from depression, comprising administering to the patient in need thereof, undergoing antidepressant therapy, a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned methods, wherein the antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned methods, wherein the antidepressant is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned methods, wherein the antidepressant is a dopamine reuptake inhibitor or an atypical antidepressant.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said sedative agent is a compound
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- a serotonin reuptake inibitor is citalop
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amoxmt of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one phannaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable canier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof. » hi certain embodiments, the present invention relates to the aforementioned uses, wherein said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof. In certain embodiments, the present invention relates to the aforementioned uses, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is a compound that modulates the
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inliibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- a serotonin reuptake inibitor is citalopram, dulox
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, 1/ polymo
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is racemic zopiclone, eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- a serotonin reuptake inhibitor wherein said
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymorph, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- said insomnia is transient insomnia.
- the present invention relates to the aforementioned uses, wherein said insomnia is short-term insomnia.
- the present invention relates to the aforementioned uses, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inliibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a serotonin reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- a serotonin reuptake inibitor is citalopram,
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a phannaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inliibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one phannaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said serotonin reuptake inhibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, poly
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a serotonin reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; and said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is racemic zopiclone, eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatinent of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a serotonin reuptake inhibitor, wherein said serotonin reuptake inibitor is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- a serotonin reuptake inhibitor
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, fluvoxamine, milnacipran, or paroxetine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said serotonin reuptake inhibitor is fluoxetine, paroxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said serotonin reuptake inhibitor is fluoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said fluoxetine is fluoxetine hydrochloride, or a pharmaceutically acceptable solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said depression is a major depressive disorder.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxapro
- the present invention relates to the aforementioned uses, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said sedative agent is a compound that modulates the activity
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of eszopiclone, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor; and at least one phannaceutically acceptable canier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepineplirine reuptake inhibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein said norepineplirine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- said present invention relates to the aforementioned uses, wherein said norepinephrine reuptake inliibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepinephrine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inliibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amoxmt of a norepinephrine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inliibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inliibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepineplirine reuptake inhibitor, wherein said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline
- the present invention relates to the aforementioned uses, wherein said norepineplirine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepineplirine reuptake inliibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is a compound that modulates the activity of a GABA
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amoxmt of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them;
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepineplirine reuptake inhibitor, wherein said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- the present invention relates to the aforementioned uses, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said insomnia is transient insomnia. In certain embodiments, the present invention relates to the aforementioned uses, wherein said insomnia is short-term insomnia. In certain embodiments, the present invention relates to the aforementioned uses, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amoxmt of a norepinephrine reuptake inliibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a norepineplirine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of norepinephrine reuptake inliibitor, wherein said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxa
- the present invention relates to the aforementioned uses, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a norepinephrine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said norepinephrine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor; and at least one pharmaceutically acceptable carrier, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of norepinephrine reuptake inhibitor, wherein said norepineplirine reuptake inhibitor is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, or (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable canier, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- the present invention relates to the aforementioned uses, wherein said norepinephrine reuptake inhibitor is desipramine, reboxetine, oxaprotiline, or (S,S)-hydroxybupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- said norepinephrine reuptake inhibitor is (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said depression is a major depressive disorder.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said sedative agent
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ - ⁇ ropanoyl-3 ⁇ -(4-tolyl)- tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- a dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ - ⁇ ropanoy
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable canier; wherein said I sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- said I sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 n
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnonnah
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and at least one phannaceutically acceptable canier; as a combined preparation for simultaneous, separate or sequential use in the treatinent of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them. In certain embodiments, the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is racemic zopic
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- a dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them. In certain embodiments, the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inliibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatinent of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amoxmt of a dopamine reuptake inliibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- the present invention relates to the aforementioned uses,wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said insomnia is transient insomnia. In certain embodiments, the present invention relates to the aforementioned uses, wherein said insomnia is short-term insomnia. In certain embodiments, the present invention relates to the aforementioned uses, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a dopamine reuptake inhibitor; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is racemic
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, as a combined preparation for simultaneous, separate or sequential use in the treatment ofdepression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)- tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- a dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them. In certain embodiments, the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable carrier;
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said dopamine reuptake inliibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a dopamine reuptake inhibitor, and at least one pharmaceutically acceptable canier; -wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said dopamine reuptake inhibitor is amineptine, bupropion, GBR-12935, venlafaxine, 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a dopamine reuptake inhibitor, wherein said dopamine reuptake inhibitor is amineptine, bupropion, GBR- 12935, venlafaxine, desmethylvenlafaxine, or 2 ⁇ -propanoyl-3 ⁇ -(4-tolyl)-tropane, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or GBR-12935, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them. h certain embodiments, the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is bupropion, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein said dopamine reuptake inhibitor is venlafaxine, desmethylvenlafaxine, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of either of them.
- said desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)- desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said depression is a major depressive disorder.
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of a sedative agent and a therapeutically effective amount of a 5-HT modulator; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2 modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT A modulator, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned uses, wherein the 5-HT A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2 modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said 5-HT modulator is MDL 1009O7, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compoimds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnonnahty.
- said sedative agent is a compound that modul
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2 modulator, and at least one pharmaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2A modulator; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein the 5-HT A modulator is a 5-HT A antagonist.
- Another aspect of the present invention relates to products for containing a therapeutically effective amomit of eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of a sleep abnormality.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compoimds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said sleep abnormality is difficulty falling asleep, difficulty staying asleep, or waking up too early.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT modulator; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 n
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2 modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2 A modulator, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is a 5-HT 2 A antagonist.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2 A modulator is a 5-HT A inverse agonist.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2 modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compomids A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of a sedative agent, a therapeutically effective amount of a 5- HT 2 modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2 A modulator; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned uses, wherein the 5-HT A modulator is a 5-HT A inverse agonist.
- Another aspect of the present invention relates to products for containinga therapeutically effective amoxmt of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of insomnia.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is piperidinyl compoimds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said insomnia is transient insomnia. In certain embodiments, the present invention relates to the aforementioned uses, wherein said insomnia is short-term insomnia. hi certain embodiments, the present invention relates to the aforementioned uses, wherein said insomnia is chronic insomnia.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2 modulator; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent and a therapeutically effective amount of a 5-HT 2 modulator; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of
- Another aspect of the present invention relates to products for containing a therapeutically effective amoxmt of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof, and a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them, as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- a 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compoimds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compoimds A, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a phamiaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2 modulator, and at least one pharmaceutically acceptable carrier; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than about 300 nM in a GABA-receptor binding assay; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- said sedative agent is a compound that modulates the activity of a GABA receptor and has a Ki less than
- Another aspect of the present invention relates to products for containing of a therapeutically effective amount of a sedative agent, a therapeutically effective amount of a 5- HT 2 modulator, and at least one phannaceutically acceptable canier; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; and said 5-HT 2 modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them; as
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT A modulator; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is a 5-HT 2A antagonist.
- the present invention relates to the aforementioned uses, wherein the 5-HT A modulator is a 5-HT 2A inverse agonist.
- Another aspect of the present invention relates to products for containing a therapeutically effective amount of eszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof; a therapeutically effective amount of a 5-HT 2A modulator, wherein said 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, phenylindole compounds A, piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a phannaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them; and at least one pharmaceutically acceptable carrier; as a combined preparation for simultaneous, separate or sequential use in the treatment of depression.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, fananserin, oxazolidine compounds A, or phenylindole compounds A, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is MDL 100907, SR 46349B, YM 992, or fananserin, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the 5-HT 2A modulator is piperidinyl compounds B, spiroazacyclic compounds C, azacyclic compounds D, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein said depression is a major depressive disorder.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for the augmentation of antidepressant therapy in a patient undergoing antidepressant therapy; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for the augmentation of antidepressant therapy in a patient undergoing antidepressant therapy; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for the augmentation of antidepressant therapy in a patient undergoing antidepressant therapy; wherein said sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the use of a therapeutically effective amomit of a sedative agent in the manufacture of a medicament for eliciting a dose sparing effect in a patient undergoing treatment with an antidepressant; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a K; less than about 300 nM in a GABA-receptor binding assay.
- the present invention relates to the use of a therapeutically effective amoxmt of a sedative agent in the manufacture of a medicament for eliciting a dose sparing effect in a patient undergoing treatinent with an antidepressant; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a , pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for eliciting a dose sparing effect in a patient undergoing treatment with an antidepressant; wherein said sedative agent is eszopiclone, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for reducing depression relapse in a patient who received antidepressant treatment; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for reducing depression relapse in a patient who received antidepressant treatment; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for reducing depression relapse in a patient who received antidepressant treatment; wherein said sedative agent is eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- said sedative agent is eszopiclone, or a phannaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein the eszopiclone is administered chronically or long-term.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for improving the efficacy of antidepressant therapy in a patient suffering from depression; wherein said sedative agent is a compound that modulates the activity of a GABA receptor and has a Kj less than about 300 nM in a GABA-receptor binding assay.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for improving the efficacy of antidepressant therapy in a patient suffering from depression; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for improving the efficacy of antidepressant therapy in a patient suffering from depression; wherein said sedative agent iseszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co- crystal thereof.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for improving the tolerability of antidepressant therapy in a patient suffering from depression; wherein said sedative agent is racemic zopiclone, eszopiclone, indiplon, zolpidem, zaleplon, gaboxadol, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the use of a therapeutically effective amount of a sedative agent in the manufacture of a medicament for improving the tolerability of antidepressant therapy in a patient suffering from depression; wherein said sedative agent iseszopiclone, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal thereof.
- the present invention relates to the aforementioned uses, wherein the antidepressant is citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, milnacipran, paroxetine, sertraline, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, ifoxetine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the antidepressant is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the antidepressant is desipramine, maprotiline, lofepramine, reboxetine, oxaprotiline, fezolamine, tomoxetine, (S,S)-hydroxybupropion, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the antidepressant is bupropion, venlafaxine, or desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clatlirate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherien the desmethylvenlafaxine is racemic desmethylvenlafaxine, (+)-desmethylvenlafaxine, or (-)-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate, clathrate, polymo ⁇ h, or co-crystal of any one of them.
- the present invention relates to the aforementioned uses, wherein the antidepressant is a dopamine reuptake inliibitor or an atypical antidepressant.
- Immediate/Sustained Release Combination Therapy Dosage Forms The combination therapy may be formulated in an immediate release dosage form or a sustained release dosage form, hi certain embodiments, the present invention relates to immediate release dosage forms of the first and second therapeutic agents.
- An immediate release dosage form may be formulated as a tablet or multiparticulate which may be encapsulated. Other immediate release dosage forms known in the art can be employed.
- the combination of therapeutic agents may be formulated to provide for an increased duration (sustained release) of therapeutic action.
- the combination therapy can be formulated to delivery the therapeutic agents at the same time or at separate times.
- the first and second therapeutic agents are administered via an oral solid dosage form that includes a sustained release carrier causing the sustained release of the first therapeutic agent, or both the first therapeutic agent and the second therapeutic agent when the dosage form contacts gastrointestinal fluid.
- the sustained release dosage form may comprise a plurality of substrates which include the drugs.
- the substrates may comprise matrix spheroids or may comprise inert pharmaceutically acceptable beads which are coated with the drugs.
- the coated beads are then preferably overcoated with a sustained release coating comprising the sustained release carrier.
- the matrix spheroid may include the sustained release carrier in the matrix itself; or the matrix may comprise a normal release matrix containing the drugs, the matrix having a coating applied thereon which comprises the sustained release carrier.
- the oral solid dosage form comprises a tablet core containing the drugs within a normal release matrix, with the tablet core being coated with a sustained release coating comprising the sustained release carrier.
- the tablet contains the drugs within a sustained release matrix comprising the sustained release carrier, hi additional embodiments, the tablet contains the first therapeutic agent within a sustained release matrix and the second therapeutic agent coated into the tablet as an immediate release layer.
- sustained release is defined for pu ⁇ oses of the present invention as the release of the therapeutic agent from the formulation at such a rate that blood (e.g., plasma) concentrations (levels) are maintained within the therapeutic range (above the minimum effective analgesic concentration or "MEAC") but below toxic levels over a period of time of about 12 hours or longer.
- the first and second therapeutic agents can be formulated as a controlled or sustained release oral formulation in any suitable tablet, coated tablet or multiparticulate formulation known to those skilled in the art.
- the sustained release dosage form may optionally include a sustained released carrier which is inco ⁇ orated into a matrix along with the active agents, or which is applied as a sustained release coating.
- the sustained release dosage form may include the first therapeutic agent in sustained release form and second therapeutic agent in the sustained release form or in immediate release form.
- the first therapeutic agent may be inco ⁇ orated into the sustained release matrix along with the second therapeutic agent; inco ⁇ orated into the sustained release coating; inco ⁇ orated as a separated sustained release layer or immediate release layer; or may be inco ⁇ orated as a powder, granulation, etc., in a gelatin capsule with the substrates of the present invention.
- the sustained release dosage form may have the first therapeutic agent in the sustained release form and the second therapeutic agent in the sustained release fonn or immediate release form.
- An oral dosage form according to the invention may be provided as, for example, granules, spheroids, beads, pellets (hereinafter collectively refened to as "multiparticulates") and/or particles.
- An amount of the multiparticulates which is effective to provide the desired dose of the therapeutic agents over time may be placed in a capsule or may be inco ⁇ orated in any other suitable oral solid form.
- the sustained release dosage form comprises such particles containing or comprising the active ingredient, wherein the particles have diameter from about 0.1 mm to about 2.5 mm, preferably from about 0.5 mm to about 2 mm.
- the particles comprise normal release matrixes containing the first therapeutic agent with the second therapeutic agent.
- the first therapeutic agent may be included in separate normal release matrix particles, or may be co-administered in a different immediate release composition which is either enveloped within a gelatin capsule or is administered separately, hi other embodiments, the particles comprise inert beads which are coated with the second therapeutic agent with the first therapeutic agents. Thereafter, a coating comprising the sustained release carrier is applied onto the beads as an overcoat.
- the particles are preferably film coated with a material that permits release of the active agents at a sustained rate in an aqueous medium. The film coat is chosen so as to achieve, in combination with the other stated properties, a desired in vitro release rate.
- the sustained release coating formulations of the present invention should be capable of producing a strong, continuous film that is smooth and elegant, capable of supporting pigments and other coating additives, non-toxic, inert, and tack-free.
- Coatings The dosage forms of the present invention may optionally be coated with one or more materials suitable for the regulation of release or for the protection of the formulation. In one embodiment, coatings are provided to permit either pH-dependent or pH-independent release, e.g., when exposed to gastrointestinal fluid.
- a pH-dependent coating serves to release the first active agent, second active agent, or both in the desired areas of the gastro-intestinal (GI) tract, e.g., the stomach or small intestine, such that an abso ⁇ tion profile is provided which is capable of providing at least about twelve hours and preferably up to twenty- four hours of therapeutic benefit to a patient.
- GI gastro-intestinal
- the coating is designed to achieve optimal release regardless of pH-changes in the environmental fluid, e.g., the GI tract.
- compositions which release a portion of the dose in one desired area of the GI tract, e.g., the stomach, and release the remainder of the dose in another area of the GI tract, e.g., the small intestine, hi certain embodiments, the first therapeutic agent is released in one area of the GI tract and the second therapeutic agent is released in a second area of the GI tract. In certain embodiments, the first and second therapeutic agents are released in nearly equal amounts at the same location in the GI tract.
- Formulations according to the invention that utilize pH-dependent coatings to obtain formulations may also impart a repeat-action effect whereby unprotected drug is coated over the enteric coat and is released in the stomach, while the remainder, being protected by the enteric coating, is released further down the gastrointestinal tract.
- Coatings which are pH- dependent may be used in accordance with the present invention include shellac, cellulose acetate phthalate (CAP), polyvinyl acetate phthalate (PVAP), hydroxypropylmethylcellulose phthalate, and methacrylic acid ester copolymers, zein, and the like.
- one aspect of the present invention relates to a formulation wherein the first therapeutic agent is coated over the enteric coat and released into the stomach while the second therapeutic agent is protected by the enteric coating and is released further down the GI tract.
- one aspect of the 5 present invention relates to a formulation wherein the second therapeutic agent is coated over the enteric coat and released into the stomach while the first therapeutic agent is protected by ) the enteric coating and is released further down the GI tract.
- the substrate e.g., tablet core bead, matrix particle
- the first therapeutic agent is coated 10 with a hydrophobic material selected from (i) an alkylcellulose; (ii) an acrylic polymer; or (iii) mixtures thereof.
- the coating may be applied in the form of an organic or aqueous solution or dispersion.
- the coating may be applied to obtain a weight gain from about 2 to about 25% of the substrate in order to obtain a desired sustained release profile.
- the invention relates to instances wherein the substrate (e.g., tablet core bead, matrix particle) containing the 15 second therapeutic agent (with or without the first therapeutic agent) is coated with a hydrophobic material.
- the substrate e.g., tablet core bead, matrix particle
- the 15 second therapeutic agent with or without the first therapeutic agent
- Such formulations are described, e.g., in detail in U.S. Pat. Nos. 5,273,760 and 5,286,493.
- Other examples of sustained release formulations and coatings which may be used in accordance with the present invention include U.S. Pat. Nos. 5,324,351; 5,356,467, and 5,472,712.
- alkylcellulose Polymers Cellulosic materials and polymers, including alkylcelluloses, provide hydrophobic materials well suited for coating the formulations according to the invention.
- one prefened alkylcellulosic polymer is ethylcellulose, although the artisan will appreciate that other cellulose and/or alkylcellulose polymers may be readily employed, singly 25 or in any combination, as all or part of a hydrophobic coating.
- One commercially-available aqueous dispersion of ethylcellulose is Aquacoat® (FMC Co ⁇ ., Philadelphia, Pa., U.S.A.).
- Aquacoat® is prepared by dissolving the ethylcellulose in a water-immiscible organic solvent and then emulsifying the same in water in the presence of a surfactant and a stabilizer. After homogenization to generate submicron droplets, the organic 30 solvent is evaporated under vacuum to form a pseudolatex. The plasticizer is not inco ⁇ orated in the pseudolatex during the manufacturing phase. Thus, prior to using the same as a coating, it is necessary to intimately mix the Aquacoat® with a suitable plasticizer prior to use.
- Surelease® Colorcon, Inc., West Point, Pa., U.S.A.
- This product is prepared by inco ⁇ orating plasticizer into the dispersion during the manufacturing process.
- a hot melt of a polymer, plasticizer (dibutyl sebacate), and stabilizer (oleic acid) is prepared as a homogeneous mixture, which is then diluted with an alkaline solution to obtain an aqueous dispersion which can be applied directly onto substrates.
- the hydrophobic material comprising the controlled release coating is a pharmaceutically acceptable acrylic polymer, including but not limited to acrylic acid and methacrylic acid copolymers, methyl methacrylate copolymers, ethoxyethyl methacrylates, cyanoethyl methacrylate, poly(acrylic acid), poly(methacrylic acid), methacrylic acid alkylamide copolymer, poly(methyl methacrylate), polymethacrylate, poly(methyl methacrylate) copolymer, polyacrylamide, aminoalkyl methacrylate copolymer, poly(methacrylic acid anhydride), and glycidyl methacrylate copolymers.
- acrylic acid and methacrylic acid copolymers including but not limited to acrylic acid and methacrylic acid copolymers, methyl methacrylate copolymers, ethoxyethyl methacrylates, cyanoethyl methacrylate, poly(acrylic acid), poly(methacrylic
- the acrylic polymer is comprised of one or more ammonio methacrylate copolymers.
- Ammonio methacrylate copolymers are well known in the art, and are copolymers of acrylic and methacrylic acid esters with a low content of quaternary ammonium groups. In order to obtain a desirable dissolution profile, it may be necessary to inco ⁇ orate in a coating two or more ammonio methacrylate copolymers having differing physical properties, such as different molar ratios of the quaternary ammonium groups to the neutral (meth)acrylic esters. Certain methacrylic acid ester-type polymers are useful for preparing pH-dependent coatings which may be used in accordance with the present invention.
- Eudragit® E is an example of a methacrylic acid copolymer which swells and dissolves in acidic media.
- Eudragit® L is a methacrylic acid copolymer which does not swell at about pH ⁇ 5.7 and is soluble at about pH>6.
- Eudragit® S does not swell at about pH ⁇ 6.5 and is soluble at about pH>7.
- Eudragit® RL and Eudragit® RS are water swellable, and the amount of water absorbed by these polymers is pH-dependent, however, dosage forms coated with Eudragit® RL and RS are pH-independent.
- the acrylic coating comprises a mixture of two acrylic resin lacquers commercially available from Rohm Pharma under the Tradenames Eudragit® RL30D and Eudragit® RS30D, respectively.
- Eudragit® RL30D and Eudragit® RS30D are copolymers of acrylic and methacrylic esters with a low content of quaternary ammonium groups, the molar ratio of ammonium groups to the remaining neutral (meth)acrylic esters being 1 :20 in Eudragit® RL30D and 1 :40 in Eudragit® RS30D.
- the mean molecular weight is about 150,000.
- the code designations RL (high permeability) and RS (low permeability) refer to the permeability properties of these agents.
- Eudragit® RL/RS mixtures are insoluble in water and in digestive fluids. However, coatings formed from the same are swellable and permeable in aqueous solutions and digestive fluids.
- the Eudragit® RL/RS dispersions of the present invention may be mixed together in any desired ratio in order to ultimately obtain a sustained release formulation having a desirable dissolution profile. Desirable sustained release formulations may be obtained, for instance, from a retardant coating derived from 100% Eudragit® RL, 50% Eudragit® RL and 50% Eudragit® RS, and 10% Eudragit® RL:Eudragit® 90% RS. Of course, one skilled in the art will recognize that other acrylic polymers may also be used, such as, for example, Eudragit® L.
- Plasticizers In embodiments of the present invention where the coating comprises an aqueous dispersion of a hydrophobic material, the inclusion of an effective amount of a plasticizer in the aqueous dispersion of hydrophobic material will further improve the physical properties of the sustained release coating. For example, because ethylcellulose has a relatively high glass transition temperature and does not form flexible films under normal coating conditions, it is preferable to inco ⁇ orate a plasticizer into an ethylcellulose coating containing sustained release coating before using the same as a coating material. Generally, the amount of plasticizer included in a coating solution is based on the concentration of the film-former, e.g., most often from about 1 to about 50 percent by weight of the film-former.
- plasticizers for ethylcellulose include water insoluble plasticizers such as dibutyl sebacate, diethyl phthalate, triethyl citrate, tributyl citrate, and triacetin, although it is possible that other water-insoluble plasticizers (such as acetylated monoglycerides, phthalate esters, castor oil, etc.) may be used.
- Triethyl citrate is an especially prefened plasticizer for the aqueous dispersions of ethyl cellulose of the present invention.
- plasticizers for the acrylic polymers of the present invention include, but are not limited to citric acid esters such as triethyl citrate NF XVI, tributyl citrate, dibutyl phthalate, and possibly 1,2-propylene glycol.
- citric acid esters such as triethyl citrate NF XVI, tributyl citrate, dibutyl phthalate, and possibly 1,2-propylene glycol.
- Other plasticizers which have proved to be suitable for enhancing the elasticity of the films fonned from acrylic films such as
- Eudragit® RL/RS lacquer solutions include polyethylene glycols, propylene glycol, diethyl phthalate, castor oil, and triacetin.
- Triethyl citrate is an especially prefened plasticizer for the aqueous dispersions of ethyl cellulose of the present invention. It has further been found that the addition of a small amount of talc reduces the tendency of the aqueous dispersion to stick during processing, and acts as a polishing agent.
- aqueous dispersion of hydrophobic material is used to coat inert pharmaceutical beads such as nu pariel 18/20 beads
- a plurality of the resultant stabilized solid controlled release beads may thereafter be placed in a gelatin capsule in an amount sufficient to provide an effective controlled release dose when ingested and contacted by an environmental fluid, e.g., gastric fluid or dissolution media.
- the stabilized controlled release bead formulations of the present invention slowly release the therapeutically active agent, e.g., when ingested and exposed to gastric fluids, and then to intestinal fluids.
- the controlled release profile of the formulations of the invention can be altered, for example, by varying the amount of overcoating with the aqueous dispersion of hydrophobic material, altering the manner in which the plasticizer is added to the aqueous dispersion of hydrophobic material, by varying the amount of plasticizer relative to hydrophobic material, by the inclusion of additional ingredients or excipients, by altering the method of manufacture, etc.
- the dissolution profile of the ultimate product may also be modified, for example, by increasing or decreasing the thickness of the retardant coating.
- Spheroids or beads coated with a therapeutically active agent are prepared, e.g., by dissolving the therapeutically active agent in water and then spraying the solution onto a substrate, for example, nu pariel 18/20 beads, using a Wuster insert.
- additional ingredients are also added prior to coating the beads in order to assist the binding of the active agents to the beads, and/or to color the solution, etc.
- a product which includes hydroxypropylmethylcellulose, etc. with or without colorant e.g., Opadry®, commercially available from Colorcon, hie.
- the resultant coated substrate in this example beads, may then be optionally overcoated with a barrier agent, to separate the therapeutically active agent from the hydrophobic controlled release coating.
- a barrier agent is one which comprises hydroxypropylmethylcellulose.
- any film-former known in the art may be used. It is prefened that the barrier agent does not affect the dissolution rate of the final product.
- the beads may then be overcoated with an aqueous dispersion of the hydrophobic material.
- the aqueous dispersion of hydrophobic material preferably further includes an effective amount of plasticizer, e.g. triethyl citrate.
- plasticizer e.g. triethyl citrate.
- Pre-formulated aqueous dispersions of ethylcellulose such as Aquacoat® or Surelease®, may be used.
- Surelease® it is not necessary to separately add a plasticizer.
- pre-formulated aqueous dispersions of acrylic polymers such as Eudragit® can be used.
- the coating solutions of the present invention preferably contain, in addition to the film-former, plasticizer, and solvent system (i.e., water), a colorant to provide elegance and product distinction. Color maybe added to the solution of the therapeutically active agent instead, or in addition to the aqueous dispersion of hydrophobic material.
- color be added to Aquacoat® via the use of alcohol or propylene glycol based color dispersions, milled aluminum lakes and opacifiers such as titanium dioxide by adding color with shear to water soluble polymer solution and then using low shear to the plasticized Aquacoat®.
- any suitable method of providing color to the formulations of the present invention may be used.
- Suitable ingredients for providing color to the formulation when an aqueous dispersion of an acrylic polymer is used include titanium dioxide and color pigments, such as iron oxide pigments. The inco ⁇ oration of pigments, may, however, increase the retard effect of the coating.
- the plasticized aqueous dispersion of hydrophobic material may be applied onto the substrate comprising the therapeutically active agent by spraying using any suitable spray equipment known in the art. i a prefened method, a Wurster fluidized-bed system is used in which an air jet, injected from underneath, fluidizes the core material and effects drying while the acrylic polymer coating is sprayed on. A sufficient amomit of the aqueous dispersion of hydrophobic material to obtain a predetermined controlled release of said therapeutically active agent when said coated substrate is exposed to aqueous solutions, e.g., gastric fluid, is preferably applied, taking into account the physical characteristics of the therapeutically active agent, the manner of inco ⁇ oration of the plasticizer, etc.
- aqueous solutions e.g., gastric fluid
- a further overcoat of a film-former such as Opadry®, is optionally applied to the beads.
- This overcoat is provided, if at all, in order to substantially reduce agglomeration of the beads.
- the release of the therapeutically active agent from the controlled release formulation of the present invention can be further influenced, i.e., adjusted to a desired rate, by the addition of one or more release-modifying agents, or by providing one or more passageways through the coating.
- the ratio of hydrophobic material to water soluble material is determined by, among other factors, the release rate required and the solubility characteristics of the materials selected.
- the release-modifying agents which function as pore-formers may be organic or inorganic, and include materials that can be dissolved, extracted or leached from the coating in the environment of use.
- the pore-formers may comprise one or more hydrophilic materials such as hydroxypropylmethylcellulose.
- the sustained release coatings of the present invention can also include erosion- promoting agents such as starch and gums.
- the sustained release coatings of the present invention can also include materials useful for making microporous lamina in the environment of use, such as polycarbonates comprised of linear polyesters of carbonic acid in which carbonate groups reoccur in the polymer chain.
- the release-modifying agent may also comprise a semi-permeable polymer.
- the release-modifying agent is selected from hydroxypropylmethylcellulose, lactose, metal stearates, and mixtures of any of the foregoing.
- the sustained release coatings of the present invention may also include an exit means comprising at least one passageway, orifice, or the like.
- the passageway maybe formed by such methods as those disclosed in U.S. Pat. Nos. 3,845,770; 3,916,889; 4,063,064; and 4,088,864.
- the passageway can have any shape such as round, triangular, square, elliptical, inegular, etc.
- the controlled release formulation is achieved via a matrix having a controlled release coating as set forth above.
- the present invention may also utilize a controlled release matrix that affords in-vitro dissolution rates of the active agent within the prefened ranges and that releases the active agent in a pH- dependent or pH-independent manner.
- the materials suitable for inclusion in a controlled release matrix will depend on the method used to form the matrix.
- a matrix in addition to the first active agent and (optionally) the second active agent may include: (1) Hydrophilic and/or hydrophobic materials, such as gums, cellulose ethers, acrylic resins, protein derived materials; the list is not meant to be exclusive, and any pharmaceutically acceptable hydrophobic material or hydrophilic material which is capable of imparting controlled release of the active agent and which melts (or softens to the extent necessary to be extruded) may be used in accordance with the present invention.
- Hydrophilic and/or hydrophobic materials such as gums, cellulose ethers, acrylic resins, protein derived materials; the list is not meant to be exclusive, and any pharmaceutically acceptable hydrophobic material or hydrophilic material which is capable of imparting controlled release of the active agent and which melts (or softens to the extent necessary to be extruded) may be used in accordance with the present invention.
- the hydrophobic material is preferably selected from the group consisting of alkylcelluloses, acrylic and methacrylic acid polymers and copolymers, shellac, zein, hydrogenated castor oil, hydrogenated vegetable oil, or mixtures thereof.
- the hydrophobic material is a pharmaceutically acceptable acrylic polymer, including but not limited to acrylic acid and methacrylic acid copolymers, methyl methacrylate, methyl methacrylate copolymers, ethoxyethyl methacrylates, cynaoethyl methacrylate, aminoalkyl methacrylate copolymer, poly(acrylic acid), poly(methacrylic acid), methacrylic acid alkylamine copolymer, poly(methyl methacrylate), poly(methacrylic acid)(anhydride), polymethacrylate, polyacrylamide, poly(methacrylic acid anhydride), and glycidyl methacrylate copolymers.
- acrylic acid and methacrylic acid copolymers including but not limited to acrylic acid and methacrylic acid copolymers, methyl methacrylate, methyl methacrylate copolymers, ethoxyethyl methacrylates, cynaoethyl methacryl
- the hydrophobic material is selected from materials such as hydroxyalkylcelluloses such as hydroxypropylmethylcellulose and mixtures of the foregoing. Prefened hydrophobic materials are water-insoluble with more or less pronounced hydrophilic and/or hydrophobic trends. Preferably, the hydrophobic materials useful in the invention have a melting point from about 30 to about 200 C, preferably from about 45 to about 90 C.
- the hydrophobic material may comprise natural or synthetic waxes, fatty alcohols (such as lauryl, myristyl, stearyl, cetyl or preferably cetostearyl alcohol), fatty acids, including but not limited to fatty acid esters, fatty acid glycerides (mono-, di-, and tri- glycerides), hydrogenated fats, hydrocarbons, normal waxes, stearic aid, stearyl alcohol and hydrophobic and hydrophilic materials having hydrocarbon backbones.
- Suitable waxes include, for example, beeswax, glycowax, castor wax and camauba wax.
- a wax-like substance is defined as any material which is normally solid at room temperature and has a melting point of from about 30 to about 100 C.
- Suitable hydrophobic materials which may be used in accordance with the present invention include digestible, long chain (Cs-Cso, especially C 1 -C 40 ), substituted or unsubstituted hydrocarbons, such as fatty acids, fatty alcohols, glyceryl esters of fatty acids, mineral and vegetable oils and natural and synthetic waxes. Hydrocarbons having a melting point of between 25 and 90 C. are prefened. Of the long chain hydrocarbon materials, fatty (aliphatic) alcohols are prefened in certain embodiments.
- the oral dosage form may contain up to 60% (by weight) of at least one digestible, long chain hydrocarbon.
- a combination of two or more hydrophobic materials are included in the matrix formulations. If an additional hydrophobic material is included, it may be selected from natural and synthetic waxes, fatty acids, fatty alcohols, and mixtures of the same. Examples include beeswax, camauba wax, stearic acid and stearyl alcohol. This list is not meant to be exclusive.
- One particular suitable matrix comprises at least one water soluble hydroxyalkyl cellulose, at least one C 12 -C 36 , preferably C 14 -C 22 , aliphatic alcohol and, optionally, at least one polyalkylene glycol.
- the at least one hydroxyalkyl cellulose is preferably a hydroxy ( to C 6 ) alkyl cellulose, such as hydroxypropylcellulose, hydroxypropylmethylcellulose and, especially, hydroxyethylcellulose.
- the amount of the at least one hydroxyalkyl cellulose in the present oral dosage form will be determined, inter alia, by the precise rate of release desired for the therapeutic agent.
- the at least one aliphatic alcohol may be, for example, lauryl alcohol, myristyl alcohol or stearyl alcohol, hi certain embodiments of the present oral dosage form, however, the at least one aliphatic alcohol is cetyl alcohol or cetostearyl alcohol.
- the amount of the at least one aliphatic alcohol in the present oral dosage form will be determined, as above, by the precise rate of release desired for the therapeutic agent. It will also depend on whether at least one polyalkylene glycol is present in or absent from the oral dosage form. In the absence of at least one polyalkylene glycol, the oral dosage form preferably contains between 20% and 50% (by wt) of the at least one aliphatic alcohol. When at least one polyalkylene glycol is present in the oral dosage form, then the combined weight of the at least one aliphatic alcohol and the at least one polyalkylene glycol preferably constitutes between 20% and 50% (by wt) of the total dosage.
- the ratio of, e.g., the at least one hydroxyalkyl cellulose or acrylic resin to the at least one aliphatic alcohol/polyalkylene glycol determines, to a considerable extent, the release rate of the active agent from the formulation.
- a ratio of the at least one hydroxyalkyl cellulose to the at least one aliphatic alcohol polyalkylene glycol of between 1 :2 and 1 :4 is prefened, with a ratio of between 1 :3 and 1 :4 being particularly prefened.
- the at least one polyalkylene glycol may be, for example, polypropylene glycol or, which is prefened, polyethylene glycol.
- the number average molecular weight of the at least one polyalkylene glycol is prefened between 1,000 and 15,000 especially between 1,500 and 12,000.
- Another suitable controlled release matrix would comprise an alkylcellulose
- the matrix includes a pharmaceutically acceptable combination of at least two hydrophobic materials.
- a controlled release matrix may also contain suitable quantities of other materials, e.g. diluents, lubricants, binders, granulating aids, colorants, flavorants and glidants that are conventional in the pharmaceutical art.
- compositions which comprise a therapeutically-effective amount of one or more of the compounds described above, formulated together with one or more pharmaceutically acceptable carriers (additives) and/or diluents.
- compositions of the present invention may be specially formulated for administration in solid or liquid form, including those adapted for the following: (1) oral administration, for example, drenches (aqueous or non-aqueous solutions or suspensions), tablets, e.g., those targeted for buccal, sublingual, and systemic abso ⁇ tion, boluses, powders, granules, pastes for application to the tongue; (2) parenteral administration, for example, by subcutaneous, intramuscular, intravenous or epidural injection as, for example, a sterile solution or suspension, or sustained-release formulation; (3) topical application, for example, as a cream, ointment, or a controlled-release patch or spray applied to the skin; (4) intravaginally or intrarectally, for example, as a pessary, cream or foam; (5) sublingually; (6) ocularly; (7) transdermally; or (8) nasally.
- oral administration for example, drenches (aqueous or non-aqueous solutions or suspension
- terapéuticaally-effective amount means that amount of a compound, material, or composition comprising a compound of the present invention which is effective for producing some desired therapeutic effect in at least a sub-population of cells in an animal at a reasonable benefit/risk ratio applicable to any medical treatment.
- pharmaceutically acceptable is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
- pharmaceutically-acceptable carrier means a pharmaceutically-acceptable material, composition or vehicle, such as a liquid or solid filler, diluent, excipient, manufacturing aid (e.g., lubricant, talc magnesium, calcium or zinc stearate, or steric acid), or solvent encapsulating material, involved in carrying or transporting the subject compound from one organ, or portion of the body, to another organ, or portion of the body.
- manufacturing aid e.g., lubricant, talc magnesium, calcium or zinc stearate, or steric acid
- solvent encapsulating material involved in carrying or transporting the subject compound from one organ, or portion of the body, to another organ, or portion of the body.
- Each carrier must be “acceptable” in the sense of being compatible with the other ingredients of the formulation and not injurious to the patient.
- materials which can serve as pharmaceutically-acceptable carriers include: (1) sugars, such as lactose, glucose and sucrose; (2) starches, such as com starch and potato starch; (3) cellulose, and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7) talc; (8) excipients, such as cocoa butter and suppository waxes; (9) oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and soybean oil; (10) glycols, such as propylene glycol; (11) polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol; (12) esters, such as ethyl oleate and ethyl laurate; (13) agar; (14) buffering agents, such as magnesium hydroxide and aluminum hydro
- “pharmaceutically-acceptable salts” in this respect, refers to the relatively non-toxic, inorganic and organic acid addition salts of compounds of the present invention. These salts can be prepared in situ in the administration vehicle or the dosage form manufacturing process, or by separately reacting a purified compound of the invention in its free base form with a suitable organic or inorganic acid, and isolating the salt thus formed during subsequent purification.
- Representative salts include the hydrobromide, hydrochloride, sulfate, bisulfate, phosphate, nitrate, acetate, valerate, oleate, palmitate, stearate, laurate, benzoate, lactate, phosphate, tosylate, citrate, maleate, fumarate, succinate, tartrate, napthylate, mesylate, glucoheptonate, lactobionate, and laurylsulphonate salts and the like.
- sulfate bisulfate
- phosphate nitrate
- acetate valerate
- oleate palmitate
- stearate laurate
- benzoate lactate
- phosphate tosylate
- citrate maleate
- fumarate succinate
- tartrate tartrate
- napthylate mesylate
- mesylate glucoheptonate
- lactobionate lactobionate
- the pharmaceutically acceptable salts of the subject compounds include the conventional nontoxic salts or quaternary ammonium salts of the compounds, e.g., from nontoxic organic or inorganic acids.
- such conventional nontoxic salts include those derived from inorganic acids such as hydrochloride, hydrobromic, sulfuric, sulfamic, phosphoric, nitric, and the like; and the salts prepared from organic acids such as acetic, propionic, succinic, glycolic, stearic, lactic, malic, tartaric, citric, ascorbic, palmitic, maleic, hydroxymaleic, phenylacetic, glutamic, benzoic, salicyclic, sulfanilic, 2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethane disulfonic, oxalic, isothionic, and the like.
- the compounds of the present invention may contain one or more acidic functional groups and, thus, are capable of forming pharmaceutically-acceptable salts with pharmaceutically-acceptable bases.
- pharmaceutically-acceptable salts refers to the relatively non-toxic, inorganic and organic base addition salts of compounds of the present invention. These salts can likewise be prepared in situ in the administration vehicle or the dosage form manufacturing process, or by separately reacting the purified compound in its free acid form with a suitable base, such as the hydroxide, carbonate or bicarbonate of a pharmaceutically-acceptable metal cation, with ammonia, or with a pharmaceutically-acceptable organic primary, secondary or tertiary amine.
- a suitable base such as the hydroxide, carbonate or bicarbonate of a pharmaceutically-acceptable metal cation, with ammonia, or with a pharmaceutically-acceptable organic primary, secondary or tertiary amine.
- Representative alkali or alkaline earth salts include the lithium, sodium, potassium, calcium, magnesium, and aluminum salts and the like.
- Representative organic amines useful for the formation of base addition salts include ethylamine, diethylamine, ethylenediamine, ethanolamine, diethanolamine, piperazine and the like. (See, for example, Berge et al., supra) Wetting agents, emulsifiers and lubricants, such as sodium lauryl sulfate and magnesium stearate, as well as coloring agents, release agents, coating agents, sweetening, flavoring and perfuming agents, preservatives and antioxidants can also be present in the compositions.
- antioxidants examples include: (1) water soluble antioxidants, such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite and the like; (2) oil-soluble antioxidants, such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propyl gallate, alpha-tocopherol, and the like; and (3) metal chelating agents, such as citric acid, ethylenediamine tetraacetic acid (EDTA), sorbitol, tartaric acid, phosphoric acid, and the like.
- water soluble antioxidants such as ascorbic acid, cysteine hydrochloride, sodium bisulfate, sodium metabisulfite, sodium sulfite and the like
- oil-soluble antioxidants such as ascorbyl palmitate, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), le
- Formulations of the present invention include those suitable for oral, nasal, topical (including buccal and sublingual), rectal, vaginal and/or parenteral administration.
- the formulations may conveniently be presented in unit dosage form and may be prepared by any methods well known in the art of pharmacy.
- the amount of active ingredient which can be combined with a canier material to produce a single dosage form will vary depending upon the host being treated, the particular mode of administration.
- the amount of active ingredient which can be combined with a carrier material to produce a single dosage form will generally be that amount of the compound which produces a therapeutic effect.
- a formulation of the present invention comprises an excipient selected from the group consisting of cyclodextrins, celluloses, liposomes, micelle forming agents, e.g., bile acids, and polymeric carriers, e.g., polyesters and polyanhydrides; and a compound of the present invention, hi certain embodiments, an aforementioned formulation renders orally bioavailable a compound of the present invention.
- Methods of preparing these formulations or compositions include the step of bringing into association a compound of the present invention with the carrier and, optionally, one or more accessory ingredients.
- the formulations are prepared by uniformly and intimately bringing into association a compound of the present invention with liquid carriers, or finely divided solid carriers, or both, and then, if necessary, shaping the product.
- Formulations of the invention suitable for oral administration may be in the form of capsules, cachets, pills, tablets, lozenges (using a flavored basis, usually sucrose and acacia or tragacanth), powders, granules, or as a solution or a suspension in an aqueous or non-aqueous liquid, or as an oil-in-water or water-in-oil liquid emulsion, or as an elixir or syrup, or as pastilles (using an inert base, such as gelatin and glycerin, or sucrose and acacia) and/or as mouth washes and the like, each containing a predetermined amount of a compound of the present invention as an active ingredient.
- lozenges using a flavored basis, usually sucrose and acacia or tragacanth
- a compound of the present invention may also be administered as a bolus, electuary or paste.
- the active ingredient is mixed with one or more pharmaceutically-acceptable carriers, such as sodium citrate or dicalcium phosphate, and/or any of the following: (1) fillers or extenders, such as starches, lactose, sucrose, glucose, mannitol, and/or silicic acid; (2) binders, such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinyl pynolidone, sucrose and/or acacia; (3) humectants, such as glycerol; (4) disintegrating agents, such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; (5) solution retarding agents, such as paraffin; (6) ab
- Solid compositions of a similar type may also be employed as fillers in soft and hard-shelled gelatin capsules using such excipients as lactose or milk sugars, as well as high molecular weight polyethylene glycols and the like.
- a tablet may be made by compression or molding, optionally with one or more accessory ingredients.
- Compressed tablets may be prepared using binder (for example, gelatin or hydroxypropylmethyl cellulose), lubricant, inert diluent, preservative, disintegrant (for example, sodium starch glycolate or cross-linked sodium carboxymethyl cellulose), surface- active or dispersing agent.
- Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
- the tablets, and other solid dosage forms of the pharmaceutical compositions of the present invention may optionally be scored or prepared with coatings and shells, such as enteric coatings and other coatings well known in the pharmaceutical-formulating art. They may also be formulated so as to provide slow or controlled release of the active ingredient therein using, for example, hydroxypropylmethyl cellulose in varying proportions to provide the desired release profile, other polymer matrices, liposomes and/or microspheres. They may be formulated for rapid release, e.g., freeze-dried.
- compositions may be sterilized by, for example, filtration through a bacteria-retaining filter, or by inco ⁇ orating sterilizing agents in the form of sterile solid compositions which can be dissolved in sterile water, or some other sterile injectable medium immediately before use.
- These compositions may also optionally contain opacifying agents and may be of a composition that they release the active ingredient(s) only, or preferentially, in a certain portion of the gastrointestinal tract, optionally, in a delayed manner.
- embedding compositions which can be used include polymeric substances and waxes.
- the active ingredient can also be in micro-encapsulated form, if appropriate, with one or more of the above-described excipients.
- Liquid dosage forms for oral administration of the compounds of the invention include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs.
- the liquid dosage forms may contain inert diluents commonly used in the art, such as, for example, water or other solvents, solubilizing agents and emulsifiers, such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, oils (in particular, cottonseed, groundnut, com, germ, olive, castor and sesame oils), glycerol, tetrahydrofuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
- inert diluents commonly used in the art, such as, for example, water or other solvents, solubilizing agents
- the oral compositions can also include adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, coloring, perfuming and preservative agents.
- Suspensions in addition to the active compounds, may contain suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, and mixtures thereof.
- Formulations of the phannaceutical compositions of the invention for rectal or vaginal administration may be presented as a suppository, which may be prepared by mixing one or more compounds of the invention with one or more suitable nonirritating excipients or carriers comprising, for example, cocoa butter, polyethylene glycol, a suppository wax or a salicylate, and which is solid at room temperature, but liquid at body temperature and, therefore, will melt in the rectum or vaginal cavity and release the active compound.
- Fonnulations of the present invention which are suitable for vaginal administration also include pessaries, tampons, creams, gels, pastes, foams or spray formulations containing such carriers as are known in the art to be appropriate.
- Dosage forms for the topical or transdermal administration of a compound of this invention include powders, sprays, ointments, pastes, creams, lotions, gels, solutions, patches and inhalants.
- the active compound may be mixed under sterile conditions with a pharmaceutically-acceptable carrier, and with any preservatives, buffers, or propellants which may be required.
- the ointments, pastes, creams and gels may contain, in addition to an active compound of this invention, excipients, such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
- Powders and sprays can contain, in addition to a compound of this invention, excipients such as lactose, talc, silicic acid, aluminum hydroxide, calcium silicates and polyamide powder, or mixtures of these substances.
- Sprays can additionally contain customary propellants, such as chlorofluorohydrocarbons and volatile unsubstituted hydrocarbons, such as butane and propane.
- Transdermal patches have the added advantage of providing controlled delivery of a compound of the present invention to the body. Such dosage forms can be made by dissolving or dispersing the compound in the proper medimn. Abso ⁇ tion enhancers can also be used to increase the flux of the compound across the skin.
- the rate of such flux can be controlled by either providing a rate controlling membrane or dispersing the compound in a polymer matrix or gel.
- Ophthalmic formulations, eye ointments, powders, solutions and the like, are also contemplated as being within the scope of this invention.
- compositions of this invention suitable for parenteral administration comprise one or more compounds of the invention in combination with one or more pharmaceutically-acceptable sterile isotonic aqueous or nonaqueous solutions, dispersions, suspensions or emulsions, or sterile powders which may be reconstituted into sterile injectable solutions or dispersions just prior to use, which may contain sugars, alcohols, antioxidants, buffers, bacteriostats, solutes which render the formulation isotonic with the blood of the intended recipient or suspending or thickening agents.
- aqueous and nonaqueous carriers examples include water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), and suitable mixtures thereof, vegetable oils, such as olive oil, and injectable organic esters, such as ethyl oleate.
- polyols such as glycerol, propylene glycol, polyethylene glycol, and the like
- vegetable oils such as olive oil
- injectable organic esters such as ethyl oleate.
- Proper fluidity can be maintained, for example, by the use of coating materials, such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
- These compositions may also contain adjuvants such as preservatives, wetting agents, emulsifying agents and dispersing agents.
- antibacterial and antifungal agents for example, paraben, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents, such as sugars, sodium chloride, and the like into the compositions. In addition, prolonged abso ⁇ tion of the injectable pharmaceutical form may be brought about by the inclusion of agents which delay abso ⁇ tion such as aluminum monostearate and gelatin.
- the therapeutic agent alone or on combination with other therapeutic agents can be employed in admixtures with conventional excipients, i.e., phannaceutically acceptable organic or inorganic carrier substances suitable for oral, parenteral, nasal, intravenous, subcutaneous, enteral, or any other suitable mode of administration, known to the art.
- conventional excipients i.e., phannaceutically acceptable organic or inorganic carrier substances suitable for oral, parenteral, nasal, intravenous, subcutaneous, enteral, or any other suitable mode of administration, known to the art.
- Suitable pharmaceutically acceptable carriers include but are not limited to water, salt solutions, alcohols, gum arabic, vegetable oils, benzyl alcohols, polyethylene glycols, gelate, carbohydrates such as lactose, amylose or starch, magnesium stearate talc, silicic acid, viscous paraffin, perfume oil, fatty acid monoglycerides and diglycerides, pentaerythritol fatty acid esters, hydroxymethylcellulose, polyvinylpynolidone, etc.
- the pharmaceutical preparations can be sterilized and if desired mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure buffers, coloring, flavoring and/or aromatic substances and the like. They can also be combined where desired with other active agents, e.g., other analgesic agents.
- auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure buffers, coloring, flavoring and/or aromatic substances and the like.
- auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure buffers, coloring, flavoring and/or aromatic substances and the like.
- other active agents e.g., other analgesic agents.
- particularly suitable are oily or
- compositions intended for oral use may be prepared according to any method known in the art and such compositions may contain one or more agents selected from the group consisting of inert, non-toxic pharmaceutically excipients which are suitable for the manufacture of tablets.
- excipients include, for example an inert diluent such as lactose; granulating and disintegrating agents such as cornstarch; binding agents such as starch; and lubricating agents such as magnesium stearate.
- the tablets may be uncoated or they may be coated by known techniques for elegance or to delay release of the active ingredients.
- Formulations for oral use may also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert diluent.
- Aqueous suspensions contain the above-identified combination of drugs and that mixture has one or more excipients suitable as suspending agents, for example pharmaceutically acceptable synthetic gums such as hydroxypropylmethylcellulose or natural gums.
- Oily suspensions may be formulated by suspending the above-identified combination of drags in a vegetable oil or mineral oil.
- the oily suspensions may contain a thickening agent such as beeswax or cetyl alcohol.
- a syrup, elixir, or the like can be used wherein a sweetened vehicle is employed.
- injectable suspensions may also be prepared, in which case appropriate liquid carriers, suspending agents and the like may be employed.
- One aspect of combination therapy pertains to a method for providing effective therapeutic treatment in humans, comprising administering an effective or sub-therapeutic amount of a first therapeutic agent; and administering an effective amount of a second therapeutic agent in an amount effective to augment the therapeutic effect provided by said first therapeutic agent.
- the second therapeutic agent can be administered before, simultaneously with, or after administration of the first therapeutic agent, as long as the dosing interval of the second therapeutic agent overlaps with the dosing interval of the first therapeutic agent (or its therapeutic effect).
- the second therapeutic agent need not be administered in the same dosage form or even by the same route of administration as the first therapeutic agent. Rather, the method is directed to the su ⁇ rising synergistic and/or additive benefits obtained in humans, when therapeutically effective levels of a first therapeutic agent have been administered to a human, and, prior to or during the dosage interval for the second therapeutic agent or while the human is experiencing the therapeutic effect, an effective amount of a second therapeutic agent to augment the therapeutic effect of the first therapeutic agent is administered.
- the second therapeutic agent is administered prior to the administration of the first therapeutic agent, it is prefened that the dosage intervals for the two drugs overlap, i.e., such that the therapeutic effect over at least a portion of the dosage interval of the first therapeutic agent is at least partly attributable to the second therapeutic agent.
- the su ⁇ rising synergistic and/or additive benefits obtained in the patient are achieved when therapeutically effective levels of the second therapeutic agent have been administered to the patient, and, during the dosage interval for the second therapeutic agent or while the patient is experiencing the therapeutic effect by virtue of the administration of a second therapeutic agent, an effective amount of a first therapeutic agent to augment the therapeutic effect of the second therapeutic agent is administered.
- combination therapy relates to an oral solid dosage form comprising an therapeutically effective amount of a first therapeutic agent together with an amount of a second therapeutic agent or pharmaceutically acceptable salt thereof which augments the effect of the first therapeutic agent.
- a second therapeutic agent or pharmaceutically acceptable salt thereof which augments the effect of the first therapeutic agent.
- delayed abso ⁇ tion of a parenterally-administered drug form is accomplished by dissolving or suspending the drug in an oil vehicle.
- injectable depot forms are made by forming microencapsule matrices of the subject compounds in biodegradable polymers such as polylactide-polyglycolide. Depending on the ratio of drug to polymer, and the nature of the particular polymer employed, the rate of drug release can be controlled. Examples of other biodegradable polymers include poly(orthoesters) and poly(anhydrides). Depot injectable formulations are also prepared by entrapping the drag in liposomes or microemulsions which are compatible with body tissue.
- the compounds of the present invention When the compounds of the present invention are administered as pharmaceuticals, to humans and animals, they can be given per se or as a pharmaceutical composition containing, for example, 0.1 to 99% (more preferably, 10 to 30%) of active ingredient in combination with a phannaceutically acceptable carrier.
- the preparations of the present invention may be given orally, parenterally, topically, or rectally. They are of course given in forms suitable for each administration route. For example, they are administered in tablets or capsule form, by injection, inhalation, eye lotion, ointment, suppository, etc. administration by injection, infusion or inhalation; topical by lotion or ointment; and rectal by suppositories. Oral administrations are prefened.
- parenteral administration and “administered parenterally” as used herein means modes of administration other than enteral and topical administration, usually by injection, and includes, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticulare, subcapsular, subarachnoid, intraspinal and intrasternal injection and infusion.
- systemic admimstration means the administration of a compound, drug or other material other than directly into the central nervous system, such that it enters the patient's system and, thus, is subject to metabolism and other like processes, for example, subcutaneous administration.
- These compounds may be administered to humans and other animals for therapy by any suitable route of administration, including orally, nasally, as by, for example, a spray, rectally, intravaginally, parenterally, intracisternally and topically, as by powders, ointments or drops, including buccally and sublingually.
- the compounds of the present invention which may be used in a suitable hydrated form, and/or the pharmaceutical compositions of the present invention, are formulated into pharmaceutically-acceptable dosage forms by conventional methods known to those of skill in the art.
- Actual dosage levels of the active ingredients in the pharmaceutical compositions of this invention may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient.
- the selected dosage level will depend upon a variety of factors including the activity of the particular compound of the present invention employed, or the ester, salt or amide thereof, the route of administration, the time of administration, the rate of excretion or metabolism of the particular compound being employed, the rate and extent of abso ⁇ tion, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular compound employed, the age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well known in the medical arts.
- a physician or veterinarian having ordinary skill in the art can readily determine and prescribe the effective amount of the pharmaceutical composition required.
- a suitable daily dose of a compound of the invention will be that amount of the compound which is the lowest dose effective to produce a therapeutic effect.
- Such an effective dose will generally depend upon the factors described above.
- oral, intravenous, intracerebro ventricular and subcutaneous doses of the compounds of this invention for a patient, when used for the indicated analgesic effects will range from about 0.0001 to about 100 mg per kilogram of body weight per day.
- the effective daily dose of the active compound may be administered as two, three, four, five, six or more sub-doses administered separately at appropriate intervals throughout the day, optionally, in unit dosage forms. Prefened dosing is one administration per day. While it is possible for a compound of the present invention to be administered alone, it is preferable to administer the compound as a pharmaceutical formulation (composition).
- the compounds according to the invention may be formulated for administration in any convenient way for use in human or veterinary medicine, by analogy with other pharmaceuticals .
- the present invention provides pharmaceutically acceptable compositions which comprise a therapeutically-effective amount of one or more of the subject compounds, as described above, formulated together with one or more pharmaceutically acceptable earners (additives) andor diluents.
- compositions of the present invention maybe specially formulated for administration in solid or liquid form, including those adapted for the following: (1) oral administration, for example, drenches (aqueous or non-aqueous solutions or suspensions), tablets, boluses, powders, granules, pastes for application to the tongue; (2) parenteral administration, for example, by subcutaneous, intramuscular or intravenous injection as, for example, a sterile solution or suspension; (3) topical application, for example, as a cream, ointment or spray applied to the skin, lungs, or mucous membranes; or (4) intravaginally or intrarectally, for example, as a pessary, cream or foam; (5) sublingually or buccally; (6) ocularly; (7) transdermally; or (8) nasally.
- oral administration for example, drenches (aqueous or non-aqueous solutions or suspensions), tablets, boluses, powders, granules, pastes for application to the tongue
- treatment is intended to encompass also prophylaxis, therapy, management and cure.
- the patient receiving this treatment is any animal in need, including primates, in particular humans, and other mammals such as equines, cattle, swine and sheep; and poultry and pets in general.
- the compound of the invention can be administered as such or in admixtures with pharmaceutically acceptable carriers and can also be administered in conjunction with antimicrobial agents such as penicillins, cephalosporins, aminoglycosides and glycopeptides.
- Conjunctive therapy thus includes sequential, simultaneous and separate administration of the active compound in a way that the therapeutical effects of the first administered one is not entirely disappeared when the subsequent is administered.
- the addition of the active compound of the invention to animal feed is preferably accomplished by preparing an appropriate feed premix containing the active compound in an effective amount and inco ⁇ orating the premix into the complete ration.
- an intermediate concentrate or feed supplement containing the active ingredient can be blended into the feed.
- the way in which such feed premixes and complete rations can be prepared and administered are described in reference books (such as "Applied Animal Nutrition", W.H. Freedman and CO., San Francisco, U.S.A., 1969 or “Livestock Feeds and Feeding" O and B books, Corvallis, Ore., U.S.A., 1977).
- Micelles Recently, the pharmaceutical industry introduced microemulsification technology to improve bioavailability of some lipophilic (water insoluble) pharmaceutical agents.
- microemulsification provides enhanced bioavailability by preferentially directing abso ⁇ tion to the lymphatic system instead of the circulatory system, which thereby bypasses the liver, and prevents destruction of the compomids in the hepatobiliary circulation.
- the fonnulations contain micelles formed from a compound of the present invention and at least one amphiphihc carrier, in which the micelles have an average diameter of less than about 10O run. More prefened embodiments provide micelles having an average diameter less than about 50 nm, and even more prefened embodiments provide micelles having an average diameter less than about 30 nm, or even less than about 20 nm.
- amphiphilic carriers While all suitable amphiphilic carriers are contemplated, the presently prefened caniers are generally those that have Generally-Recognized-as-Safe (GRAS) status, and that can both solubilize the compound of the present invention and microemulsify it at a later stage when the solution comes into a contact with a complex water phase (such as one found in human gastrointestinal tract).
- GRAS Generally-Recognized-as-Safe
- amphiphilic ingredients that satisfy these requirements have HLB (hydrophilic to lipophilic balance) values of 2-20, and their structures contain straight chain aliphatic radicals in the range of C-6 to C-20. Examples are polyethylene-glycolized fatty glycerides and polyethylene glycols.
- Particularly prefened amphiphilic carriers are saturated and monounsaturated polyethyleneglycolyzed fatty acid glycerides, such as those obtained from fully or partially hydrogenated various vegetable oils.
- oils may advantageously consist of tri-. di- and mono-fatty acid glycerides and di- and mono-poly ethyleneglycol esters of the conesponding fatty acids, with a particularly prefened fatty acid composition including capric acid 4-10, capric acid 3-9, lauric acid 40-50, myristic acid 14-24, palmitic acid 4-14 and stearic acid 5- 15%.
- amphiphilic carriers include partially esterified sorbitan and/or sorbitol, with saturated or mono-unsaturated fatty acids (SPAN-series) or conesponding ethoxylated analogs (TWEEN-series).
- Amphiphilic carriers are particularly contemplated, including Gelucire-series, Labrafil, Labrasol, or Lauroglycol (all manufactured and distributed by Gattefosse Co ⁇ oration, Saint Priest, France), PEG-mono-oleate, PEG-di-oleate, PEG-mono- laurate and di-laurate, Lecithin, Polysorbate 80, etc (produced and distributed by a number of companies in USA and worldwide) .
- Hydrophilic polymers suitable for use in the present invention are those which are readily water-soluble, can be covalently attached to a vesicle-forming lipid, and which are tolerated in vivo without toxic effects (i.e., are biocompatible).
- Suitable polymers include polyethylene glycol (PEG), polylactic (also termed polylactide), polyglycolic acid (also termed polyglycolide), a polylactic-polyglycolic acid copolymer, and polyvinyl alcohol.
- Prefened polymers are those having a molecular weight of from about 100 or 120 daltons up to about 5,000 or 10,000 daltons, and more preferably from about 300 daltons to about 5,000 daltons.
- the polymer is polyethyleneglycol having a molecular weight of from about 100 to about 5,000 daltons, and more preferably having a molecular weight of from about 300 to about 5,000 daltons.
- the polymer is polyethyleneglycol of 750 daltons (PEG(750)).
- Polymers may also be defined by the number of monomers therein; a prefened embodiment of the present invention utilizes polymers of at least about three monomers, such PEG polymers consisting of three monomers (approximately 150 daltons).
- hydrophilic polymers which may be suitable for use in the present invention include polyvinylpynolidone, polymethoxazoline, polyethyloxazoline, polyhydroxypropyl methacrylamide, polymethacrylamide, polydimethylacrylamide, and derivatized celluloses such as hydroxymethylcellulose or hydroxyethylcellulose.
- a formulation of the present invention comprises a biocompatible polymer selected from the group consisting of polyamides, polycarbonates, polyalkylenes, polymers of acrylic and methacrylic esters, polyvinyl polymers, polyglycolides, polysiloxanes, polyurethanes and co-polymers thereof, celluloses, polypropylene, polyethylenes, polystyrene, polymers of lactic acid and glycolic acid, polyanhydrides, poly(ortho)esters, poly(butic acid), poly(valeric acid), poly(lactide-co-caprolactone), polysaccharides, proteins, polyhyaluronic acids, polycyanoacrylates, and blends, mixtures, or copolymers thereof.
- a biocompatible polymer selected from the group consisting of polyamides, polycarbonates, polyalkylenes, polymers of acrylic and methacrylic esters, polyvinyl polymers, polyglycolides, polysiloxanes, polyurethanes and
- Cyclodextrins are cyclic oligosaccharides, consisting of 6, 7 or 8 glucose units, designated by the Greek letter .alpha., .beta, or .gamma., respectively. Cyclodextrins with fewer than six glucose units are not known to exist. The glucose units are linked by alpha- 1,4- glucosidic bonds. As a consequence of the chair conformation of the sugar units, all secondary hydroxyl groups (at C-2, C-3) are located on one side of the ring, while all the primary hydroxyl groups at C-6 are situated on the other side. As a result, the external faces are hydrophilic, making the cyclodextrins water-soluble.
- the cavities of the cyclodextrins are hydrophobic, since they are lined by the hydrogen of atoms C-3 and C-5, and by ether-like oxygens.
- These matrices allow complexation with a variety of relatively hydrophobic compounds, including, for instance, steroid compounds such as 17.beta.-estradiol (see, e.g., van Uden et al. Plant Cell Tiss. Org. Cult. 38:1-3-113 (1994)).
- the complexation takes place by Van der Waals interactions and by hydrogen bond formation.
- the physico-chemical properties of the cyclodextiin derivatives depend strongly on the kind and the degree of substitution. For example, their solubility in water ranges from insoluble (e.g., triacetyl-beta-cyclodextrin) to 147% soluble (w/v) (G-2-beta-cyclodextrin). hi addition, they are soluble in many organic solvents.
- the properties of the cyclodextrins enable the control over solubility of various formulation components by increasing or decreasing their solubility. Numerous cyclodextrins and methods for their preparation have been described. For example, Parmeter (I), et al. (U.S. Pat. No. 3,453,259) and Gramera, et al.
- Small unilamellar vesicles have a single membrane and typically range between 0.02 and 0.05 ⁇ m in diameter; large unilamellar vesicles (LUVS) are typically larger than 0.05 ⁇ m Oligolamellar large vesicles and multilamellar vesicles have multiple, usually concentric, membrane layers and are typically larger than 0.1 ⁇ m.
- Liposomes with several nonconcentric membranes, i.e., several smaller vesicles contained within a larger vesicle, are termed multivesicular vesicles.
- One aspect of the present invention relates to formulations comprising liposomes containing a compound of the present invention, where the liposome membrane is formulated to provide a liposome with increased canying capacity.
- the compound of the present invention may be contained within, or adsorbed onto, the liposome bilayer of the liposome.
- the compound of the present invention may be aggregated with a lipid surfactant and carried within the liposome's internal space; in these cases, the liposome membrane is formulated to resist the disruptive effects of the active agent-surfactant aggregate.
- the lipid bilayer of a liposome contains lipids derivatized with polyethylene glycol (PEG), such that the PEG chains extend from the inner surface of the lipid bilayer into the interior space encapsulated by the liposome, and extend from the exterior of the lipid bilayer into the surrounding environment.
- Active agents contained within liposomes of the present invention are in solubilized form. Aggregates of surfactant and active agent (such as emulsions or micelles containing the active agent of interest) maybe entrapped within the interior space of liposomes according to the present invention.
- a surfactant acts to disperse and solubilize the active agent, and may be selected from any suitable aliphatic, cycloaliphatic or aromatic surfactant, including but not limited to biocompatible lysophosphatidylcholines (LPCs) of varying chain lengths (for example, from about C 14 to about C 20 ).
- LPCs lysophosphatidylcholines
- Polymer-derivatized lipids such as PEG-lipids may also be utilized for micelle formation as they will act to inhibit micelle/membrane fusion, and as the addition of a polymer to surfactant molecules decreases the CMC of the surfactant and aids in micelle formation.
- Liposomes according to the present invention may be prepared by any of a variety of techniques that are known in the art. See, e.g., U.S. Pat. No.
- liposomes of the present invention may be prepared by diffusing a lipid derivatized with a hydrophilic polymer into preformed liposomes, such as by exposing preformed liposomes to micelles composed of lipid-grafted polymers, at lipid concentrations conesponding to the final mole percent of derivatized lipid which is desired in the liposome.
- Liposomes containing a hydrophilic polymer can also be formed by homogenization, lipid-field hydration, or extrusion techniques, as are known in the art.
- the active agent is first dispersed by sonication in a lysophosphatidylcholine or other low CMC surfactant (including polymer grafted lipids) that readily solubilizes hydrophobic molecules.
- the resulting micellar suspension of active agent is then used to rehydrate a dried lipid sample that contains a suitable mole percent of polymer-grafted lipid, or cholesterol.
- the liposomes are prepared to have substantially homogeneous sizes in a selected size range.
- One effective sizing method involves extruding an aqueous suspension of the liposomes through a series of polycarbonate membranes having a selected uniform pore size; the pore size of the membrane will conespond roughly with the largest sizes of liposomes produced by extrusion through that membrane. See e.g., U.S. Pat. No. 4,737,323 (Apr. 12, 1988).
- release Modifiers The release characteristics of a formulation of the present invention depend on the encapsulating material, the concentration of encapsulated drug, and the presence of release modifiers. For example, release can be manipulated to be pH dependent, for example, using a pH sensitive coating that releases only at a low pH, as in the stomach, or a higher pH, as in the intestine. An enteric coating can be used to prevent release from occurring until after passage through the stomach. Multiple coatings or mixtures of cyanamide encapsulated in different materials can be used to obtain an initial release in the stomach, followed by later release in the intestine. Release can also be manipulated by inclusion of salts or pore forming agents, which can increase water uptake or release of drug by diffusion from the capsule.
- Excipients which modify the solubility of the drug can also be used to control the release rate.
- Agents which enhance degradation of the matrix or release from the matrix can also be inco ⁇ orated. They can be added to the drug, added as a separate phase (i.e., as particulates), or can be co- dissolved in the polymer phase depending on the compound, hi all cases the amount should be between 0.1 and thirty percent (w/w polymer).
- Types of degradation enhancers include inorganic salts such as ammonium sulfate and ammonium chloride, organic acids such as citric acid, benzoic acid, and ascorbic acid, inorganic bases such as sodium carbonate, potassium carbonate, calcium carbonate, zinc carbonate, and zinc hydroxide, and organic bases such as protamine sulfate, spermine, choline, ethanolamine, diethanolamine, and triethanolamine and surfactants such as Tween® and Pluronic®.
- Pore forming agents which add microstructure to the matrices i.e., water soluble compounds such as inorganic salts and sugars
- the range should be between one and thirty percent (w/w polymer). Uptake can also be manipulated by altering residence time of the particles in the gut.
- a mucosal adhesive polymer examples include most polymers with free carboxyl groups, such as cliitosan, celluloses, and especially polyacrylates (as used herein, polyacrylates refers to polymers including acrylate groups and modified acrylate groups such as cyanoacrylates and methacrylates).
- any method of preparing a matrix formulation known to those skilled in the art may be used.
- inco ⁇ oration in the matrix may be effected, for example, by (a) forming granules comprising at least one water soluble hydroxyalkyl cellulose and the active agent; (b) mixing the hydroxyalkyl cellulose containing granules with at least one C. sub.12 -C. sub.36 aliphatic alcohol; and (c) optionally, compressing and shaping the granules.
- the granules are formed by wet granulating the hydroxyalkyl cellulose/active agent with water.
- the amount of water added during tie wet granulation step is preferably between 1.5 and 5 times, especially between 1.75 and 3.5 times, the dry weight of the active agent.
- a spheronizing agent, together with the active ingredient can be spheronized to form spheroids.
- Microcrystalline cellulose is prefened.
- a suitable microcrystalline cellulose is, for example, the material sold as Avicel PH 101 (Trade Mark, FMC Co ⁇ oration).
- the spheroids may also contain a binder. Suitable binders, such as low viscosity, water soluble polymers, will be well known to those skilled in the pharmaceutical art. However, water soluble hydroxy lower alkyl cellulose, such as hydroxypropylcellulose, are prefened. Additionally (or alternatively) the spheroids may contain a water insoluble polymer, especially an acrylic polymer, an acrylic copolymer, such as a methacrylic acid-ethyl acrylate copolymer, or ethyl cellulose.
- the sustained release coating will generally include a hydrophobic material such as (a) a wax, either alone or in admixture with a fatty alcohol; or (b) shellac or zein.
- a hydrophobic material such as (a) a wax, either alone or in admixture with a fatty alcohol; or (b) shellac or zein.
- Melt Extrusion Matrix Sustained release matrices can also be prepared via melt-granulation or melt-extrusion techniques. Generally, melt-granulation techniques involve melting a normally solid hydrophobic material, e.g. a wax, and inco ⁇ orating a powdered drag therein. To obtain a sustained release dosage form, it may be necessary to inco ⁇ orate an additional hydrophobic substance, e.g. ethylcellulose or a water-insoluble acrylic polymer, into the molten wax hydrophobic material.
- an additional hydrophobic substance e.g. ethylcellulose or a water-
- the additional hydrophobic material may comprise one or more water- insoluble waxlike thermoplastic substances possibly mixed with one or more wax-like thermoplastic substances being less hydrophobic than said one or more water-insoluble wax- like substances.
- the individual wax-like substances in the formulation should be substantially non-degradable and insoluble in gastrointestinal fluids during the initial release phases.
- Useful water-insoluble wax-like substances may be those with a water- solubility that is lower than about 1:5,000 (w/w).
- a sustained release matrix may also contain suitable quantities of other materials, e.g., diluents, lubricants, binders, granulating aids, colorants, flavorants and glidants that are conventional in the pharmaceutical art.
- suitable quantities of these additional materials will be sufficient to provide the desired effect to the desired formulation
- a sustained release matrix inco ⁇ orating melt- extruded multiparticulates may also contain suitable quantities of other materials, e.g. diluents, lubricants, binders, granulating aids, colorants, flavorants and glidants that are conventional in the pharmaceutical art in amounts up to about 50% by weight of the particulate if desired.
- melt Extrusion Multiparticulates The preparation of a suitable melt-extruded matrix according to the present invention may, for example, include the steps of blending the active agent, together with at least one hydrophobic material and preferably the additional hydrophobic material to obtain a homogeneous mixture. The homogeneous mixture is then heated to a temperature sufficient to at least soften the mixture sufficiently to extrude the same. The resulting homogeneous mixture is then extruded to form strands. The extradate is preferably cooled and cut into multiparticulates by any means known in the art.
- the strands are cooled and cut into multiparticulates.
- the multiparticulates are then divided into unit doses.
- the extradate preferably has a diameter of from about 0.1 to about 5 mm and provides sustained release of the therapeutically active agent for a time period of from about 8 to about 24 hours.
- An optional process for preparing the melt extrusions of the present invention includes directly metering into an extrader a hydrophobic material, a therapeutically active agent, and an optional binder; heating the homogenous mixture; extruding the homogenous mixture to thereby form strands; cooling the strands containing the homogeneous mixture; cutting the strands into particles having a size from about 0.1 mm to about 12 mm; and dividing said particles into unit doses.
- the diameter of the extrader aperture or exit port can also be adjusted to vary the thickness of the extruded strands.
- the exit part of the extrader need not be round; it can be oblong, rectangular, etc.
- the exiting strands can be reduced to particles using a hot wire cutter, guillotine, etc.
- the melt extruded multiparticulate system can be, for example, in the form of granules, spheroids or pellets depending upon the extrader exit orifice.
- melt-extruded multiparticulate(s) and “melt-extruded multiparticulate system(s)” and “melt-extruded particles” shall refer to a plurality of units, preferably within a range of similar size and/or shape and containing one or more active agents and one or more excipients, preferably including a hydrophobic material as described herein.
- the melt-extruded multiparticulates will be of a range of from about 0.1 to about 12 rmn in length and have a diameter of from about 0.1 to about 5 mm.
- melt-extruded multiparticulates can be any geometrical shape within this size range.
- the extradate may simply be cut into desired lengths and divided into unit doses of the therapeutically active agent without the need of a spheronization step.
- oral dosage forms are prepared to include an effective amount of melt-extruded multiparticulates within a capsule.
- a plurality of the melt-extruded multiparticulates may be placed in a gelatin capsule in an amount sufficient to provide an effective sustained release dose when ingested and contacted by gastric fluid.
- a suitable amount of the multiparticulate extradate is compressed into an oral tablet using conventional tableting equipment using standard techniques.
- the extradate can be shaped into tablets as set forth in U.S. Pat. No. 4,957,681 (Klimesch, et. al.).
- the sustained release melt-extruded multiparticulate systems or tablets can be coated, or the gelatin capsule can be further coated, with a sustained release coating such as the sustained release coatings described above.
- Such coatings preferably include a sufficient amount of hydrophobic material to obtain a weight gain level from about 2 to about 30 percent, although the overcoat may be greater depending upon the physical properties of the particular active agent utilized and the desired release rate, among other things.
- the melt-extruded unit dosage forms of the present invention may further include combinations of melt-extruded multiparticulates containing one or more of the therapeutically active agents disclosed above before being encapsulated. Furthermore, the unit dosage forms can also include an amount of an immediate release therapeutically active agent for prompt therapeutic effect.
- the immediate release therapeutically active agent may be inco ⁇ orated, e.g., as separate pellets within a gelatin capsule, or may be coated on the surface of the multiparticulates after preparation of the dosage fonns (e.g., controlled release coating or matrix-based).
- the unit dosage forms of the present invention may also contain a combination of controlled release beads and matrix multiparticulates to achieve a desired effect.
- the sustained release formulations of the present invention preferably slowly release the therapeutically active agent, e.g., when ingested and exposed to gastric fluids, and then to intestinal fluids.
- the sustained release profile of the melt-extruded formulations of the invention can be altered, for example, by varying the amount of retardant, i.e., hydrophobic material, by varying the amount of plasticizer relative to hydrophobic material, by the inclusion of additional ingredients or excipients, by altering the method of manufacture, etc.
- the melt extruded material is prepared without the inclusion of the therapeutically active agent, which is added thereafter to the extradate.
- Such formulations typically will have the therapeutically active agent blended together with the extruded matrix material, and then the mixture would be tableted in order to provide a slow release formulation.
- Such formulations may be advantageous, for example, when the therapeutically active agent included in the formulation is sensitive to temperatures needed for softening the hydrophobic material and/ or the retardant material.
- sedative agents, antidepressants including without limitation, serotonin reuptake inhibitors, norepinephrine reuptake inhibitors, and 5-HT 2A modulators are chiral compounds that can exist as a racemic mixture, a non-equal mixture of enantiomers, or as a single enantiomer.
- enantiomeric excess is well known in the art and is defined for a resolution of ab ⁇ a + b as: cone, of a - cone, of b ee « x 100 cone, of a X cone, of b
- the temi "enantiomeric excess” is related to the older term “optical purity” in that both are measures of the same phenomenon.
- the value of e.e. will be a number from 0 to 1O0, zero being racemic and 100 being pure, single enantiomer.
- a compound which in the past might have been called 98% optically pure is now more precisely described as 96% e.e.; in other words, a 90% e.e. reflects the presence of 95% of one enantiomer and 5% of the other in the material in question.
- compositions comprising a specified enantiomer contain the specified enantiomer in at least 90% e.e. More preferably, such compositions comprising a specified enantiomer contain the specified enantiomer in at least 95% e.e. Even more preferably, such compositions comprising a specified enantiomer contain the specified enantiomer in at least 98% e.e.
- compositions comprising a specified enantiomer contain the specified enantiomer in at least 99% e.e.
- compositions comprising eszopiclone contain the S-enantiomer of zopiclone in at least 90% e.e.
- compositions comprising eszopiclone contain the S-enantiomer of zopiclone in at least 95% e.e.
- such compositions comprising eszopiclone contain the S-enantiomer of zopiclone in at least 98% e.e.
- compositions comprising eszopiclone contain the S-enantiomer of zopiclone in at least 99% e.e.
- the term "serotonin reuptake inhibitor” refers to a compound that at least partially inhibits the reuptake of serotonin.
- the serotonin reuptake inliibitor is a selective serotonin reuptake inliibitor.
- selective serotonin reuptake inhibitor refers to a compound that preferentially inhibits serotonin reuptake relative to its ability to modulate the activity of other receptors.
- norepinephrine reuptake inhibitor refers to a compound that at least partially inhibits the reuptake of norepineplirine.
- the norepineplirine reuptake inhibitor is a selective norepinephrine reuptake inhibitor.
- selective norepinephrine reuptake inhibitor refers to a compound that preferentially inhibits norepinephrine reuptake relative to its ability to modulate the activity of other receptors.
- 5-HT 2A modulator refers to a compound that modulates the activity of 5- HT 2A receptor.
- 5-HT 2A modulator includes 5-HT A antagonists and 5-HT A inverse agonists and 5-HT 2A partial agonists.
- antagonists refers to a compound that binds to a receptor site, but does not cause any physiological changes.
- inverse agonist and negative antagonist and “neutral antagonist” refer to compounds that inhibit an unoccupied, but active receptor.
- patient refers to a mammal in need of a particular treatment. In a prefened embodiment, a patient is a primate, canine, feline, or equine. In another prefened embodiment, a patient is a human.
- co-administration and “co-administering” refer to both concunent administration (administration of two or more therapeutic agents at the same time) and time varied administration (administration of one or more therapeutic agents at a time different from that of the administration of an additional therapeutic agent or agents), as long as the therapeutic agents are present in the patient to some extent at the same time.
- solvate refers to a phannaceutically acceptable fonn of a specified compound, with one or more solvent molecules, that retains the biological effectiveness of such compound.
- solvates include compounds of the invention in combination with solvents such, for example, water (to form the hydrate), isopropanol, ethanol, methanol, dimethyl sulfoxide, ethyl acetate, acetic acid, ethanolamine, or acetone. Also included are formulations of solvate mixtures such as a compound of the invention in combination with two or more solvents.
- solvents such as water (to form the hydrate), isopropanol, ethanol, methanol, dimethyl sulfoxide, ethyl acetate, acetic acid, ethanolamine, or acetone.
- formulations of solvate mixtures such as a compound of the invention in combination with two or more solvents.
- screened subject refers to any subject who signs the Informed Consent and completes at least one study related procedure.
- screen failure subject refers to any subject who has signed the informed consent and completed at least one study related procedure and discontinues for any reason prior to receiving any study medication.
- the term "completed subject” refers to any subject who completes all study visits.
- the term “early termination subject” refers to any subject who is assigned a randomization number but does not complete all study visits.
- the phrases "sleep disorders” or “sleep abnormality” refers to primary insomnia; secondary insomnia; situational insomnia; transient insomnia; short-tenn insomnia; chronic insomnia; acute insomnia; prolonged latency to sleep onset; difficulty falling asleep; difficulty staying asleep; sleep maintenance problems, including without limitation, frequent awakenings, an increase in time spent awake after initially falling asleep (wake time after sleep onset, or WASO), sleep fragmentation, transient microarousals, and unrefreshing sleep; increased time awake during the sleep period; waking up too early; and reduced total sleep time.
- WASO wake time after sleep onset
- depression refers to major depression, major depressive disorder, mild depression, moderate depression, severe depression without psychosis, severe depression with psychosis, dysthymia, bipolar disorder, or manic depression.
- antidepressant refers to compounds used to treat depression, including without limitation: tricyclic antidepressents, such as clomipramine, amoxapine, nortriptyline, moprotilene, trimipramine, imipramine, or protriptyline; monoamine oxidase inhibitors; serotonin reuptake inhibitors, including selective serotonin reuptake inihibitors, such as citalopram, escitalopram, duloxetine, fluoxetine, sertraline, norsertraline, paroxetine,, mirtrazepine, fluvoxamine, milnacipran, clominpramine, femoxetine, indapline, alaprolclate, cericlamine, or ifox
- insomnia is the most disabling of the depressive symptom complex, hi addition, many subjects are treated with selective serotonin re-uptake inhibitors (SSRIs) that may accentuate insomnia initially following treatment with these agents.
- SSRIs serotonin re-uptake inhibitors
- This study aims to establish that the early addition of continuous eszopiclone 3 mg at bedtime to a standard antidepressant treatment with fluoxetine hydrochloride (20 or 40 mg) daily in the morning for 8 weeks is safe and provides improved sleep to depressed subjects. Beyond direct impact on sleep efficacy measures, differences in time to onset and amplitude of antidepressant effects, and improvements in quality of life and functional restoration are investigated A primary objective of the present study was to evaluate subjective sleep efficacy during eight weeks of treatment with eszopiclone 3 mg nightly (at bed time) in subjects with insomnia related to major depressive disorder and treated concunently with fluoxetine hydrochloride.
- a secondary objective of the study was to evaluate the potential for eszopiclone 3 mg to augment the antidepressant effect of fluoxetine hydrochloride by investigating the differences in time to onset and amplitude of antidepressant responses over an 8-week treatment period.
- Study Design This study was a double-blind randomized, placebo-controlled, parallel group study.
- Visit 1 After signing the Informed Consent, subjects were screened with the following assessments: administration of the Hamilton Depression Rating Scale (17 item; HAM-D-17) via interactive voice response system, medical and sleep history, physical examination including vital signs, clinical laboratory assessments, and standard 12-lead electrocardiogram (ECG). Subjects returned for Visit 2 within 5 to 14 days.
- Visit 2 Subjects meeting inclusion and exclusion criteria begin a 3-7 day baseline period. At this visit safety assessments and evaluation of adverse events (AEs) were perfonned. In addition, subjects were trained on use of the interactive voice response system (IVRS) system for collection of sleep and depression endpoints and the frequency of assessments. Subjects completed 7 selected items of the HAM-D-17 via lNRS the morning after this visit. During this 3-7 day period, subjects made daily IVRS calls to evaluate sleep parameters, and depression symptoms [Daily Telephone Assessment (DTA) and Symptoms Questionnaire (SQ; 23 -item Depression subscale)].
- DTA Dynaily Telephone Assessment
- SQ Symptoms Questionnaire
- Visit 3 End of Week 0; Randomization: Subjects with a minimum of three complete IVRS assessments during the baseline week were randomized to eszopiclone 3 mg or matching placebo nightly (at bedtime) for eight weeks in addition to taking open-label fluoxetine hydrochloride administered in the morning. On the morning of this visit (prior to the visit), subjects completed the Hamilton Depression Rating Scale (7 selected items of the HAM-D-17) via IVRS in addition to the daily sleep diary. At this visit, the HAM-D-17 was administered by a clinician; safety assessments and evaluation of adverse effects (AEs) were performed; and the study drag was dispensed. Following this visit, subjects continued to make daily IVRS calls to evaluate sleep and depression symptoms until the morning of Visit 4.
- AEs adverse effects
- Visits 4 On the morning of each visit, subjects completed the 7 selected items of the HAM-D-17 and sleep diary via IVRS. In clinic, the subject completed sleep and quality of life questionnaires. In addition, the HAM-D-17 was administered by a clinician (at Visits 7 and 9 only); safety assessments and an evaluation of AEs were performed; and study drag and supplies were dispensed. On the morning following each office visit, subjects completed the sleep diary and depression symptoms questionnaires via IVRS. Beginning one week prior to Visit 9 until Visit 10, subjects resumed daily IVRS for completion of the sleep diary.
- Sample Population Approximately 600 subjects were randomized in order to complete 360. Subjects are males and females between the ages of 21 and 64, inclusive. All subjects were required to meet the DSM IV criteria for insomnia related to a major depressive disorder. Subjects must have reported all of the following: sleep onset time > 30 minutes, wake time after sleep onset > 45 minutes and total sleep time of ⁇ 6.5 hours. Subjects must also have had a minimum HAM-D-17 score of 14, not including scores for sleep items, at Visit 1. Dose Description: All subjects received fluoxetine hydrochloride 20 mg daily until Week 4 (Visit 7).
- WASO wake time after sleep onset
- TST Mean subjective total sleep time
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PL04813295T PL1691811T3 (pl) | 2003-12-11 | 2004-12-08 | Skojarzenie leku uspokajającego i modulatora neuroprzekaźnikowego oraz sposoby poprawy jakości snu i leczenia depresji |
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PCT/US2004/040962 WO2005060968A1 (en) | 2003-12-11 | 2004-12-08 | Combination of a sedative and a neurotransmitter modulator, and methods for improving sleep quality and treating depression |
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US7927613B2 (en) | 2002-02-15 | 2011-04-19 | University Of South Florida | Pharmaceutical co-crystal compositions |
US7790905B2 (en) | 2002-02-15 | 2010-09-07 | Mcneil-Ppc, Inc. | Pharmaceutical propylene glycol solvate compositions |
US20030224006A1 (en) | 2002-03-01 | 2003-12-04 | Zaworotko Michael J. | Multiple-component solid phases containing at least one active pharmaceutical ingredient |
US20050025791A1 (en) | 2002-06-21 | 2005-02-03 | Julius Remenar | Pharmaceutical compositions with improved dissolution |
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2004
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- 2004-12-08 ES ES04813295.5T patent/ES2515092T3/es active Active
- 2004-12-08 WO PCT/US2004/040962 patent/WO2005060968A1/en active Application Filing
- 2004-12-08 DK DK04813295.5T patent/DK1691811T3/da active
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- 2004-12-08 EP EP04813295.5A patent/EP1691811B1/de active Active
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- 2004-12-08 US US11/007,795 patent/US20050176680A1/en not_active Abandoned
- 2004-12-08 JP JP2006543929A patent/JP5646126B2/ja not_active Expired - Fee Related
- 2004-12-08 EP EP11158892A patent/EP2343073A3/de not_active Ceased
- 2004-12-08 AU AU2004305563A patent/AU2004305563C1/en not_active Ceased
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Non-Patent Citations (1)
Title |
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See references of WO2005060968A1 * |
Also Published As
Publication number | Publication date |
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DK1691811T3 (da) | 2014-10-20 |
US20120122874A1 (en) | 2012-05-17 |
CA2548917A1 (en) | 2005-07-07 |
US20140343069A1 (en) | 2014-11-20 |
PL1691811T3 (pl) | 2014-12-31 |
AU2004305563C1 (en) | 2011-07-07 |
AU2004305563B2 (en) | 2010-12-16 |
WO2005060968A1 (en) | 2005-07-07 |
US8097625B2 (en) | 2012-01-17 |
PT1691811E (pt) | 2014-10-30 |
AU2011201056A1 (en) | 2011-03-31 |
JP5646126B2 (ja) | 2014-12-24 |
JP2011162557A (ja) | 2011-08-25 |
EP1691811B1 (de) | 2014-07-23 |
HK1095279A1 (en) | 2007-05-04 |
AU2004305563A1 (en) | 2005-07-07 |
US20070299055A1 (en) | 2007-12-27 |
CA2548917C (en) | 2014-09-23 |
JP2007513956A (ja) | 2007-05-31 |
US20050176680A1 (en) | 2005-08-11 |
ES2515092T3 (es) | 2014-10-29 |
EP2343073A2 (de) | 2011-07-13 |
EP2343073A3 (de) | 2011-10-12 |
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